预防性腹部排水与左胰腺切除术后没有排水:系统性审查和元分析
Ning Xia1, Li Wang1, Xing Huang1
1Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
Gland surgery
|December 16, 2024
概括
在左胰腺切除术 (LP) 后,不需要进行常规的腹部排水. 没有排水的方法是安全的,并降低了手术后胰腺 (POPF) 率,导致更短的住院时间.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 基于证据的医学基于证据的医学.
背景情况:
- 在左胰腺切除术 (LP) 后,预防性腹部排水是常见的做法.
- 越来越多的证据表明排水可能是不必要的.
- 这次元分析评估了结果,以提供最终的建议.
研究的目的:
- 为了比较经过排水的患者和没有经过LP的患者之间的术后结果.
- 为了确定在LP之后预防性腹部排水的必要性.
主要方法:
- 在主要数据库 (PubMed,MEDLINE,Embase,Web of Science,Cochrane Library) 进行广泛的文献搜索,截至2024年7月.
- 包括10项研究 (2项RCT,8项OCS) 涉及3,505名患者.
- 使用基于异质性的固定效应或随机效应模型进行元分析,计算聚合的OR和MD,其CI为95%.
主要成果:
- 在RCT (OR=0.79,P=0.22) 中的组之间,主要发病率没有显著差异 (Clavien-Dindo ≥III).
- 在没有排水的组中,术后胰腺抽等级B/C (POPF B/C) 的发生率显著降低 (RCTs:OR=0.47,P<0.001).
- 在没有排水组中观察到较短的住院时间. 在重新操作,再接收或死亡率方面没有差异.
结论:
- 遵循LP的无排水政策是安全有效的.
- 实施无排水方法与POPF B/C的降低率有关.
- 这一策略提供了潜在的好处,包括更短的住院时间.
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