Braun吻合对胰十二指肠切除术后并发症影响的Meta分析

摘要

objective To systematically evaluate and analyze the influence of Braun enteroenterostomy (BEE) applicated in pancreatoduodenectomy on the postoperative complication, especially on the incidence of delayed gastric emptying (DGE). Methods The documents about BEE were searched in Cochrane Library, PubMed, Embase, Web of Science, Chinese biomedicine database, CNKI, VIP database and Wanfang database, from the begining of database established till to Mar. 2016. The quality of included studies was assessed accord-ing to the Cochrane systematic review method and statistical analysis of data was performed by RevMan 5.3 soft-ware. Results Ten studies concerning 1 554 patients were included. The pooled analysis indicated that, the inci-dence of overall morbidity (OR=0.61, 95%CI=0.47~0.81, P=0.0006) and the total incidence of DGE (OR=0.36, 95%CI=0.19~0.67, P=0.001) were lower in BEE group. In the 8 studies adopted International Study Group of Pancreatic Surgery (ISGPS) standard, the total incidence of DGE (OR=0.36, 95%CI=0.18~0.72, P=0.004), the DGE with grade B (OR=0.36, 95%CI=0.11~1.17, P=0.09) and grade C (OR=0.28, 95%CI=0.16~0.48, P<0.001) were also lower in BEE group. Conclusion Meta-analysis shows that BEE may reduce the incidence of overall morbidity and the total incidence of DGE, especially the incidence of DGE with grade C.%目的：系统评价Braun吻合（BEE）对胰十二指肠切除术（PD）术后并发症的影响，重点分析对术后胃排空障碍（DGE）的影响，以探讨BEE的价值和意义，为临床应用提供循证医学方面的客观依据。方法计算机检索CochraneLibrary、PubMed、Embase、WebofScience、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、维普和万方数据库关于BEE的相关文献，检索时间均从建库至2016年3月。按Cochrane系统评价的方法评价纳入研究的质量，使用RevMan5.3软件对研究资料进行统计分析。结果共纳入10篇文献，总计1544例患者。Meta分析结果显示：所有纳入文献中BEE组术后总并发症发生率（OR=0.61，95%CI=0.47～0.81，P=0.0006）和术后总DGE发生率（OR=0.36，95%CI=0.19～0.67，P=0.001）要低于非BEE组。同样，采用国际胰腺外科研究学组（ISGPS）标准的8篇文献中，BEE组总DGE发生率（OR=0.36，95%CI=0.18～0.72，P=0.004），B级DGE发生率（OR=0.36，95%CI=0.11～1.17，P=0.09）和C级DGE发生率（OR=0.28，95%CI=0.16～0.48，P＜0.01）均要低于非BEE组。结论 Meta分析显示，BEE可以降低PD术后总并发症的发生率和DGE的发生率，尤其是可以降低C级DGE的发生率。