【摘要】：目的:評價胰十二指腸切除術后胰胃吻合術與胰空腸吻合術的療效。方法:通過計算機檢索1994年1月1日至2014年8月31日在Cochrane、PubMed、Medline、EMBASE、Science Direct、Springerlink、CBM數(shù)據(jù)庫、中國知網(wǎng)、萬方以及維普數(shù)據(jù)庫公開發(fā)表的文獻及相關文章的參考文獻。按照納入及排除標準,經(jīng)篩選后納入的Meta分析的RCT文獻共13篇,對所納入的文獻進行質(zhì)量評估并提取數(shù)據(jù)。以術后胰漏、腹腔感染、膽漏、胃排空障礙,術后出血、并發(fā)癥,總死亡率為觀察指標。應用RevMan5.2軟件進行統(tǒng)計學分析。采用x2檢驗分析統(tǒng)計學異質(zhì)性,若P≥0.10,則采用固定效應模型進行Meta分析,若P0.10,則采用隨機效應模型進行Meta分析。按照各文獻數(shù)據(jù)提取結(jié)果對各個結(jié)局指標進行統(tǒng)計分析并繪制森林圖,計數(shù)資料選取比數(shù)比(OR)及其95%可信區(qū)間(95%CI)表示,計量資料以均數(shù)差(MD)及其95%可信區(qū)間(95%CI)表示,發(fā)表偏倚用漏斗圖評估,P0.05認為有統(tǒng)計學意義。結(jié)果:按照檢索策略和資料收集方法,共檢索到文獻1684篇,篩選后最終納入13篇RCT文獻,其中英文10篇,中文碩士學位論文3篇,13篇文獻質(zhì)量評價優(yōu)良。13個研究納入病例1870例,其中PG組904例,PJ組966例。Meta分析結(jié)果顯示:PG和PJ相比,PG組能降低術后胰漏發(fā)病率,合并OR值:0.54,95%CI:0.44-0.70,P0.00001。PG組能降低術后腹腔感染的發(fā)病率,合并OR值:0.46,95%CI:0.32-0.660,P0.0001,PG組膽漏發(fā)病率也有所降低,合并OR值:0.47,95%CI:0.27-0.82,P0.008。術后胃排空障礙合并OR值:1.22,95%CI:0.88-1.70,P0.23;術后出血合并OR:1.11,95%CI:0.77-1.59,P=0.58,術后并發(fā)癥合并OR:0.96,95%CI:0.76-1.20,P0.70,術后死亡率合并OR值:0.77,95%CI:0.44-1.32,P0.34。結(jié)論:PG在術后胰漏、膽漏、腹腔感染的發(fā)病率方面優(yōu)于PJ,在胃排空障礙、術后出血、術后總并發(fā)癥發(fā)病率、死亡率方面的差異無統(tǒng)計學意義,但此結(jié)果仍需多中心、大樣本、前瞻性RCT研究驗證。
[Abstract]:Objective: to evaluate the effect of pancreaticogastrostomy and pancreaticojejunostomy after pancreaticoduodenectomy. Methods: from January 1, 1994 to August 31, 2014, we searched the CBM database published in Cochraneberg Medline, EMBASE Science Direct link CBM, China Zhiwang, Wanfang and Weip databases, and the references of related articles. According to the inclusion and exclusion criteria, 13 RCT articles were selected and analyzed by Meta. The quality of the literature was evaluated and the data were extracted. Postoperative pancreatic leakage, intraperitoneal infection, bile leakage, gastric emptying disorder, postoperative bleeding, complications and total mortality were taken as indexes. RevMan5.2 software was used for statistical analysis. The statistical heterogeneity was analyzed by x2 test. If P 鈮，

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