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prophylactic intra-peritoneal drain placement following pancreaticoduodenectomy:A systematic review and metaanalysis

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World Journal of Gastroenterology 2015年第8期21卷 2510-2521页

作者： Yi-Chao Wang p.ter szatmary Jing-Qiang Zhu Jun-Jie Xiong Wei Huang Ilias Gomatos Quentin M Nunes Robert Sutton Xu-Bao Liu Department of Thyroid and Breast Surgery West China Hospital Sichuan University NIHR Liverpool pancreas Biomedical Research Unit Royal Liverpool University Hospital University of Liverpool Department of pancreatic Surgery West China Hospital Sichuan University

AIM:To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy(pD)with or without prophylactic ***:Relevant comparative randomized and nonrandomized studies were systemically searched based on specific inclusion and exclusion *** outcomes were compared between patients with and those without routine *** odds ratios(OR)with 95%CI were calculated using either fixed effects or random effects ***:One randomized controlled trial and four non-randomized comparative studies recruiting 1728patients were *** without prophylactic drainage after pD had significantly higher mortality(OR=2.32,95%CI:1.11-4.85;p=0.02),despite the fact that they were associated with fewer overall complications(OR=0.62,95%CI:0.48-0.82;p=0.00),major complications(OR=0.75,95%CI:0.60-0.93;p=0.01)and readmissions(OR=0.77,95%CI:0.60-0.98;p=0.04).There were no significant differences in the rates of pancreatic fistula,intraabdominal abscesses,postpancreatectomy hemorrhage,biliary fistula,delayed gastric emptying,reoperation or radiologic-guided drains between the two ***:Indiscriminate abandonment of intraabdominal drainage following pD is associated with greater mortality,but lower complication *** randomized trials should compare routine vs selective drainage.

关键词： pancreaticoduodenectomy Drain Metaanalysis Morbidi

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Meta-analysis of subtotal stomach-preserving pancreaticoduodenectomy vs pylorus preserving pancreaticoduodenectomy

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World Journal of Gastroenterology 2015年第20期21卷 6361-6373页

作者： Wei Huang Jun-Jie Xiong Mei-Hua Wan p.ter szatmary Shameena Bharucha Ilias Gomatos Quentin M Nunes Qing Xia Robert Sutton Xu-Bao Liu Sichuan provincial pancreatitis Center Department of Integrated Traditional Chinese Medicine and Western MedicineWest China HospitalSichuan University Department of pancreatic Surgery West China HospitalSichuan University NIHR Liverpool pancreas Biomedical Research Unit Royal Liverpool University Hospital

AIM: To investigate the differences in outcome following pylorus preserving pancreaticoduodenectomy(pppD) and subtotal stomach-preserving pancreaticoduodenectomy(SSppD).METHODS: Major databases including pub Med(Medline), EMBASE and Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials(CENTRAL) in The Cochrane Library were searched for comparative studies between patients with pppD and SSppD published between January 1978 and July 2014. Studies were selected based on specific inclusion and exclusion criteria. The primary outcome was delayed gastric emptying(DGE). Secondary outcomes included operation time, intraoperative blood loss, pancreatic fistula, postoperative hemorrhage, intraabdominal abscess, wound infection, time to starting liquid diet, time to starting solid diet, period of nasogastric intubation, reinsertion of nasogastric tube, mortality and hospital stay. The pooled odds ratios(OR) or weighted mean difference(WMD) with 95% confidence intervals(95%CI) were calculated using either a fixed-effects or random-effects model. RESULTS: Eight comparative studies recruiting 650 patients were analyzed, which include two RCTs, one non-randomized prospective and 5 retrospective trial designs. patients undergoing SSppD experienced significantly lower rates of DGE(OR = 2.75; 95%CI: 1.75-4.30, p ter period of nasogastric intubation(OR = 2.68; 95%CI: 0.77-4.58,p ter time to liquid(WMD = 2.97, 95%CI:-0.46-7.83; p = 0.09) and solid diets(WMD = 3.69, 95%CI:-0.46-7.83; p = 0.08) as well as shorter inpatient stay(WMD = 3.92, 95%CI:-0.37-8.22; p = 0.07), although these latter three did not reach statistical significance. pppD, however, was associated with less intraoperative blood loss than SSppD [WMD =-217.70, 95%CI:-429.77-(-5.63); p = 0.04]. There were no differences in other parameters between the two approaches, including operative time(WMD =-5.30, 95%CI:-43.44-32.84; p = 0.79

关键词： pancreaticoduodenectomy pylorus preservingSubtotal stomach preserving pancreaticoduodenectomy Delayed gastric emptying pancreatic surgery Metaanalysis

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