Objective To explore the risk factors of domestic pancreatic leakage after pancreatoduodenectomy(PD) ,and provide a theoretical basis in reducing the rate of clinical pancreatic leakage postoperative,improve the prognosis of patients treated. Method Meta analysis was used in 19 articles on risk factors of the national pancreatic leakage after pancreaticoduodenectomy published in China from January 1980 to January 2010. Results Between the group of patients older than 65 years with the group less than 65 years the incidence of pancreatic leakage was no significant difference,Combined OR =0.84(95% CI:0.49 ～ 1.44 P <0.05). The incidence of pancreatic leakage after PD was no significant difference in male and female patients,combined OR = 1. 14(95% CI:0.78～ 1.66 P = 0.51). In the group of patient whose level of preoperative jaundice higher than 171 pmol/L the incidence of pancreatic leakage after PD was significantly higher( combined OR = 1.87 95% CI:1. 14～3. 07 P<0.05).The rate of pancreatic leakage after PD With or without diabetes had no significant relationship occurred ( P > 0.05 ). Preoperative albumin level less than 30 g/L group would increased incidence of postoperative pancreatic leakage( combined OR = 0. 33 95% Cl :0. 16 ～0. 67 P < 0.01). The traditional sets of binding a-greement-in could reduce the incidence of postoperative pancreatic leakage, the difference was statistically significant( combined OR = 0.25 95% Cl:0.13 ～0.51 P<0. 01). Then the traditional set-in pancreatic anastomosis leakage rate was lower than the mucous membranes of the mucosal anastomosis groups, the difference was statistically significant (combined OR =0.34 95% Cl:0.18～0. 66 P < 0.01). Pancreatic duct diameter greater than 3 mm has lower pancreatic leakage rate than less than 3mm group(P< 0.001). The incidence of pancreatic leakage after operation has statistical differences in pancreatic duct drainage group and no pancreatic duct drainage (P<0.05). In the pancreatic leakage group and healing group blood loss had no significant difference. (P>0.05) ;Between pancreatic leakage and healing group the time of operation had no significant difference ( P > 0.05 ). The incidence of postoperative pancreatic leakage 8.48% (of 23/271) in the group which was used somatostatin postoperative,and 15.53% (32/206) in the group not used(P< 0.05 ). Conclusion Pancreatic leakage after PD occurrence and sex, age, diabetes, blood loss, surgical time had no relationship. Preoperative jaundice is higher than 171 μmol/L,preoperative hypoalbuminemia,pancreatic duct diameter less than equal to 3 mm,pancre-atojejunostomy choice .whether to place pancreatic duct drainage support, prophylactic use of somatostatin are factors affecting the risk of pancreatic leakage.%目的 分析探讨国内胰十二指肠切除术后胰漏的危险因素,为临床有效降低术后并发症提供理论依据.方法 运用Meta分析方法对我国自1980年1月至2010年1月期间公开发表的有关胰十二指肠术后胰漏危险因素的16篇文献资料进行合并分析.结果 年龄、性别、有无糖尿病与胰漏发生无统计学意义(P＞0.05);术前黄疸水平大于171 μmol/L组PD术后胰漏发生率明显高于对照组(合并OR值1.8795％ CI:1.14～3.07P＜0.05);术前白蛋白水平低于30 g/L组患者术后胰漏发生率增高(合并OR值0.33 95％ CI:0.16～0.67 P＜0.01);捆绑式吻合较传统套入式及黏膜对黏膜吻合能有效降低术后胰漏发生率(合并OR值0.25 95％ CI:0.13 ～0.51 P＜0.01);胰管直径大于3mm组胰漏发生率明显低于胰管直径小于等于3mm组(P＜0.001);放置胰管支撑引流组较未放置胰管支撑引流组术后胰漏发生率低(P＜0.05);胰漏组与愈合组术中出血量及手术时间无显著性差异(P＞0.05);术后使用生长抑素组术后胰漏发生率明显低于未使用组(P＜0.05).结论 胰十二指肠切除术后胰漏的发生与性别、年龄、有无糖尿病、术中出血量、手术时间等无关.而术前高胆红素血症、低蛋白血症、胰管直径细小、胰肠吻合方式的选择、是否放置胰管支撑引流、术后预防性使用生长抑素等是影响胰漏的危险因素.
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