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中华消化病与影像杂志(电子版) ›› 2022, Vol. 12 ›› Issue (06) : 361 -366. doi: 10.3877/cma.j.issn.2095-2015.2022.06.008

循证医学

超声内镜引流治疗胰腺手术后胰周积液的系统回顾和Meta分析
范爱娟1, 牟海萍1,()   
  1. 1. 250021 济南市槐荫人民医院超声科
  • 收稿日期:2022-09-09 出版日期:2022-12-01
  • 通信作者: 牟海萍

Systematic review and Meta-analysis of endoscopic ultrasound drainage for peripancreatic fluid collection after pancreatic surgery

Aijuan Fan1, Haiping Mou1,()   

  1. 1. Department of Ultrasound, Huaiyin People′s Hospital of Jinan, Jinan 250021, China
  • Received:2022-09-09 Published:2022-12-01
  • Corresponding author: Haiping Mou
引用本文:

范爱娟, 牟海萍. 超声内镜引流治疗胰腺手术后胰周积液的系统回顾和Meta分析[J]. 中华消化病与影像杂志(电子版), 2022, 12(06): 361-366.

Aijuan Fan, Haiping Mou. Systematic review and Meta-analysis of endoscopic ultrasound drainage for peripancreatic fluid collection after pancreatic surgery[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2022, 12(06): 361-366.

目的

系统评估超声内镜引导引流(EUSD)治疗胰腺手术后胰周积液(PFC)的效果。

方法

检索中英文数据中EUSD和经皮穿刺引流术(PCD)治疗PFC的文献,质量评价后进行Meta分析,比较EUSD和PCD对PFC患者操作成功率、临床成功率、并发症发生率、住院时间、复发率的影响。

结果

共纳入7篇回顾性队列研究,文献NOS得分7分1篇,8分2篇,9分4篇。Meta分析显示EUSD和PCD治疗PFC的操作成功率(OR 0.92,95% CI 0.92~4.72,P=0.92)、临床成功率(OR 1.52,95% CI 0.79~2.92,P=0.21)、并发症发生率(OR 0.59,95% CI 0.26~1.36,P=0.22)、复发率(OR 1.00,95% CI 0.36~2.73,P=1.00)相比较差异均无统计学意义。EUSD治疗PFC的住院时间低于PCD(MD-2.80,95% CI-5.50~-0.07,P=0.04)。

结论

与PCD相比较,EUSD治疗胰腺手术后PFC具有类似的操作成功率、临床有效率、并发症发生率和复发率,且可减少住院时间,是治疗PFC安全可行的方法。

Objective

To systematically evaluate the efficacy of endoscopic ultrasound-guided drainage(EUSD)in the treatment of peripancreatic fluid collection(PFC)after pancreatic surgery.

Methods

The literatures on the treatment of PFC with EUSD and percutaneous puncture drainage(PCD)in Chinese and English were retrieved.After quality evaluation, meta-analysis was conducted to compare the effects of EUSD and PCD on the operation success rate, clinical success rate, complication rate, hospitalization time and recurrence rate of PFC patients.

Results

A total of 7 retrospective cohort studies were included, including 1 article with 7 NOS points, 2 articles with 8 points and 4 articles with 9 points.Meta analysis showed that there were no statistically significant differences in the operation success rate(OR=0.92, 95% CI: 0.92-4.72, P=0.92), clinical success rate(OR=1.52, 95% CI: 0.79-2.92, P=0.21), complication rate(OR=0.59, 95% CI: 0.26-1.36, P=0.22)and recurrence rate(OR=1.00, 95% CI: 0.36-2.73, P=1.00)between EUSD and PCD in the treatment of PFC.The hospitalization time of PFC treated with EUSD was shorter than that treated with PCD(MD=-2.80, 95% CI: -5.50--0.07, P=0.04).

Conclusion

Compared with PCD, EUSD has similar operation success rate, clinical effective rate, complication rate and recurrence rate in the treatment of PFC after pancreatic surgery, and can reduce the hospitalization time.It is a safe and feasible method for the treatment of PFC.

图1 文献纳入流程图
表1 纳入研究的7篇文献特征
表2 纳入研究的7篇文献NOS评分结果(分)
图2 EUSD和PCD治疗PFC操作成功率的森林图注:PFC胰周液体积聚;PCD经皮穿刺引流术;EUSD超声内镜引导引流术
图3 EUSD和PCD治疗PFC临床成功率的森林图注:PFC胰周液体积聚;PCD经皮穿刺引流术;EUSD超声内镜引导引流术
图4 EUSD和PCD治疗PFC并发症发生率的森林图注:PFC胰周液体积聚;PCD经皮穿刺引流术;EUSD超声内镜引导引流术
图5 EUSD和PCD治疗PFC住院时间的森林图注:PFC胰周液体积聚;PCD经皮穿刺引流术;EUSD超声内镜引导引流术
图6 EUSD和PCD治疗PFC复发率的森林图注:PFC胰周液体积聚;PCD经皮穿刺引流术;EUSD超声内镜引导引流术
图7 EUSD和PCD治疗PFC临床成功率的倒漏斗图注:PFC胰周液体积聚;PCD经皮穿刺引流术;EUSD超声内镜引导引流术
1
Maeda KKuriyama NNakagawa Y,et al.Optimal management of peripancreatic fluid collection with postoperative pancreatic fistula after distal pancreatectomy:Significance of computed tomography values for predicting fluid infection[J].PLoS One202116(11):e0259701.
2
Pedrazzoli SLiessi GPasquali C,et al.Postoperative pancreatic fistulas:preventing severe complications and reducing reoperation and mortality rate[J].Ann Surg2009249(1):97-104.
3
Caillol FGodat STurrini O,et al.Fluid collection after partial pancreatectomy:EUS drainage and long-term follow-up[J].Endosc Ultrasound20198(2):91-98.
4
Vin YSima CSGetrajdman GI,et al.Management and outcomes of postpancreatectomy fistula,leak,and abscess:results of 908 patients resected at a single institution between 2000 and 2005[J].J Am Coll Surg2008207(4):490-498.
5
Kawaida HKono HHosomura N,et al.Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery[J].World J Gastroenterol201925(28):3722-3737.
6
Denzer UWSioulas ADAbdulkarim M,et al.Endoscopic ultrasound-guided drainage of abdominal fluid collections after pancreatic surgery:efficacy and long-term follow-up[J].Z Gastroenterol201654(9):1047-1053.
7
Banks PABollen TLDervenis C,et al.Classification of acute pancreatitis-2012:revision of the Atlanta classification and definitions by international consensus[J].Gut201362(1):102-11.
8
李幼平,杨晓妍,李鸿浩.知证卫生决策工具附件—评估设计(改编自Cochrane干预措施系统评价手册)(文18附件2)[J].中国循证医学杂志201010(6):647.
9
艾飞玲,胡葵茹,石钰霖,等.基于纽卡斯尔-渥太华量表对中国吸烟队列研究文献的质量评价[J].中华疾病控制杂志202125(6):722-729.
10
Al Efishat MAttiyeh MAEaton AA,et al.Endoscopic versus percutaneous drainage of post-operative peripancreatic fluid collections following pancreatic resection[J].HPB(Oxford)201921(4):434-443.
11
Azeem NBaron THTopazian MD,et al.Outcomes of endoscopic and percutaneous drainage of pancreatic fluid collections arising after pancreatic tail resection[J].J Am Coll Surg2012215(2):177-85.
12
Futagawa YImazu HMori N,et al.The Effectiveness and Feasibility of Endoscopic Ultrasound-guided Transgastric Drainage of Postoperative Fluid Collections Early After Pancreatic Surgery[J].Surg Laparosc Endosc Percutan Tech201727(4):267-272.
13
Jürgensen CDistler MArlt A,et al.EUS-guided drainage in the management of postoperative pancreatic leaks and fistulas(with video)[J].Gastrointest Endosc201989(2):311-319.e1.
14
Kwon YMGerdes HSchattner MA,et al.Management of peripancreatic fluid collections following partial pancreatectomy:a comparison of percutaneous versus EUS-guided drainage[J].Surg Endosc201327(7):2422-7.
15
Onodera MKawakami HKuwatani M,et al.Endoscopic ultrasound-guided transmural drainage for pancreatic fistula or pancreatic duct dilation after pancreatic surgery[J].Surg Endosc201226(6):1710-7.
16
Tamura TKitano MKawai M,et al.Effectiveness of endoscopic ultrasound-guided drainage for noncapsulated postoperative pancreatic collection[J].Therap Adv Gastroenterol201912:1756284819884418.
17
Taniwaki SMuroya DWada Y,et al.Pancreaticoenterostomy With Seromuscular-parenchymal Anastomosis for Prevention of Postoperative Pancreatic Fistula in Distal Pancreatectomy[J].Anticancer Res202242(8):4153-4157.
18
Zhang BYuan QLi S,et al.Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy:A systematic review and meta-analysis[J].Medicine(Baltimore)2022101(26):e29757.
19
Miranda AJürgensen CChekerov R,et al.EUS-guided Transgastric Drainage to Manage a Postoperative Pancreatic Fistula After Distal Pancreatectomy and Splenectomy in Recurrent Ovarian Cancer:A Case Report[J].Anticancer Res202141(7):3649-3656.
20
Washio MYamashita KNiihara M,et al.Postoperative pancreatic fistula after gastrectomy for gastric cancer[J].Ann Gastroenterol Surg20204(6):618-627.
21
Ramouz AShafiei SAli-Hasan-Al-Saegh S,et al.Systematic review and meta-analysis of endoscopic ultrasound drainage for the management of fluid collections after pancreas surgery[J].Surg Endosc202236(6):3708-3720.
22
Mohan BPShakhatreh MDugyala S,et al.EUS versus percutaneous management of postoperative pancreatic fluid collection:a systematic review and meta-analysis[J].Endosc Ultrasound20198(5):298-309.
23
Prachayakul VAswakul P.Endoscopic ultrasound-guided biliary drainage as an alternative to percutaneous drainage and surgical bypass[J].World J Gastrointest Endosc20157(1):37-44.
24
Giovannini MBories ETéllez-Ávila FI.Endoscopic ultrasound-guided bilio-pancreatic drainage[J].Endosc Ultrasound20121(3):119-129.
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