摘要
目的 用循证医学的方法 评价预防性使用生长抑素能否降低胰十二指肠切除术后并发症。方法 检索1966年到2006年7月间发表的有关胰十二指肠切除术预防性使用生长抑素的效果的随机对照临床试验。按入选和排除标准，有7项临床试验纳入本研究，由2名评价者对入选研究中有关试验设计、研究对象的特征、研究结果 等内容独立进行摘录，用RevMan4.2软件进行分析。结果 对于胰十二指肠切除术生长抑素预防性使用组和不使用组两组之间胰瘘（OR=0.70，95%CI：0.42～1.16，P=0.17）、总并发症（OR=1.12，95%CI：0.73～1.70，P=0.61）、住院期间死亡数（OR= 1.61，95%CI：0.52～5.03，P=0.41）、住院天数（OR=-2.87，95%CI：-9.83～4.10，P=0.42）差异均无统计学意义。结论 预防性使用生长抑素并不能降低胰十二指肠切除术后胰瘘、总并发症、住院期间死亡数和住院天数，不推荐在胰十二指肠切除术前和术后常规应用生长抑素来预防术后并发症。
Objective To evaluate the effectiveness of somatostatin and analogues in the prevention of postoperative pancreatic fistula and other complications in patients undergoing pancreaticoduodenectomy. Methods The data available on Medline, EMBASE and China Biological Medicine Disk from Jan 1966 to July 2006 were searched and 7 studies were enrolled into this analysis. The detail about the trial design, characters of the subjects, results of the studies were reviewed by two independent analysis and analyzed by Revman 4. 2 software. Results Compared with placebo or no treatment, the use of octreotide or somatostatin was not associated with significantly lower incidence of pancreatic fistula （ OR = 0. 70,95% CI： 0.42 - 1.16, P = 0. 17 ） , total complication rate （ OR = 1.12,95 % CI：0. 73 - 1.70, P = 0.61 ）, hospital death （ OR = 1.61,95% CI： 0. 52 - 5.03, P = 0. 41 ） and hospital stay （ days ） （ OR = - 2. 87,95% CI： -9. 83 -4. 10, P = O. 42）. The ＂funnel plot＂ of the studies in the meta-analysis did not show any publication bias. We analysed these studies of using octreotide and tetradecapeptide somatostatine, separately. The incidence of postoperative pancreatic fistula was not different between octreotide and placebo groups in four studies （ OR 95% CI, 0. 69 - 1.87 ; P = 0. 61 ）. There was also no significant difference between the tetradecapeptide somatostatine and placebo groups （OR 95% CI, 0. 15 - 1.24; P = 0. 12）. After the studies of low quality （ Jadad scores 〈 3 ） were excluded, the incidences of pancreatic fistulas, delayed gastric emptying, any complication, mortality, postoperative hospital stay for somatostatine against placebo all did not show any significant differences. The result was same to the above including the studies of low quality. Conclusion Prophylactic use of octreotide or somatostatin does not reduce the incidence of pancreatic fistula, total complication rate, hospital death and hospital stay after pancreaticoduodenectomy. The routine use of octreotide or somatostatin after pancreaticoduodenectomy should not be recommended.
出处
《中华普通外科杂志》
CSCD
北大核心
2007年第9期694-697,共4页
Chinese Journal of General Surgery
