Tehnike zatvaranja panja pankreasa i formiranje fistule gušterače nakon distalne pankreatektomije: metaanaliza i jednocentarno iskustvo.
PloS one
Sažetak istraživanja
Pozadina Pankreasna fistula/PF je najčešća komplikacija koja se boji nakon distalne pankreatektomije/DP. Međutim, najsigurnija tehnika zatvaranja panjeva gušterače ostaje stalna debata. Ovdje smo imali za cilj uporediti sigurnost različitih tehnika zatvaranja panjeva pankreasa za prevenciju PF tokom DP.
Metode Izvršili smo PRISMA-baziranu meta-analizu svih relevantnih studija koje su upoređivale najmanje dvije tehnike zatvaranja panjeva tokom DP-a s obzirom na stope PF/PFR. Dalje smo izvršili retrospektivnu analizu našeg institucionalnog PFR-a u korelaciji sa tehnikama zatvaranja panjeva.
Rezultati Prvobitno je identifikovana 8301 studija. Od ovih, deset randomiziranih kontrolisanih studija/RCT, jedanaest prospektivnih i 59 retrospektivnih studija bilo je prihvatljivo. Zatvaranje klamericom (26% vs. 31%, OR:0,73, p = 0,02), kombinacija heftalice i šava (30% vs. 33%, OR:0,70, p = 0,05), ili anastomoza panjeva (14% vs. 28%, OR:0,51, p = 0) su bile povezane samo sa zatvaranjem. Očuvanje slezene/splenektomija, ili laparoskopski/otvoreni DP, TachoSil®, nanošenje ljepila nalik fibrinu ili pojačanja za spajanje (Seamguard®) nisu uticali na PFR nakon DP. Nasuprot tome, autologni flasteri (falciformni ligamenti/seromuskularne zakrpe) rezultirali su nižim PFR nego bez primjene flastera (21,9% vs. 25,8%, OR:0,60, p = 0,006). U našoj ustanovi, tri glavne tehnike zatvaranja panjeva rezultirale su uporedivim PFR (šav:27%, klamerica:29%, ili kombinacija:24%). Međutim, selektivno šivanje/šivanje glavnog kanala pankreasa tokom zatvaranja panja pankreasa sprečilo je tešku PF (p = 0,02).
Zaključak Nakon DP-a, zatvaranje klamericom, anastomoza pankreasa ili falciformni/seromuskularni zakrpe dovode do nižeg PFR-a nego samo zatvaranje šavom. Međutim, razlike su prilično male i potrebni su dodatni RCT testovi za testiranje ovih efekata. Selektivno zatvaranje glavnog kanala pankreasa tokom zatvaranja panja može spriječiti tešku PF.
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Pancreatic stump closure techniques and pancreatic fistula formation after distal pancreatectomy: Meta-analysis and single-center experience.
Background Pancreatic fistula/PF is the most frequent and feared complication after distal pancreatectomy/DP. However, the safest technique of pancreatic stump closure remains an ongoing debate. Here, we aimed to compare the safety of different pancreatic stump closure techniques for preventing PF during DP.
Methods We performed a PRISMA-based meta-analysis of all relevant studies that compared at least two techniques of stump closure during DP with regard to PF rates/PFR. We further performed a retrospective analysis of our institutional PFR in correlation with stump closure techniques.
Results 8301 studies were initially identified. From these, ten randomized controlled trials/RCTs, eleven prospective and 59 retrospective studies were eligible. Stapler closure (26%vs.31%, OR:0.73, p = 0.02), combination of stapler and suture (30%vs.33%, OR:0.70, p = 0.05), or stump anastomosis (14%vs.28%, OR:0.51, p = 0.02) were associated with lower PFR than suture closure alone. Spleen preservation/splenectomy, or laparoscopic/open DP, TachoSil®, fibrin-like glue-application, or bioabsorbable-stapler-reinforcements (Seamguard®) did not influence PFR after DP. In contrast, autologous patches (falciform ligament/seromuscular patches) resulted in lower PFR than no patch application (21.9%vs.25,8%, OR:0.60, p = 0.006). In our institution, the major three techniques of stump closure resulted in comparable PFR (suture:27%, stapler:29%, or combination:24%). However, selective suturing/clipping of the main pancreatic duct during pancreatic stump closure prevented severe PF (p = 0.02).
Conclusion After DP, stapler closure, pancreatic anastomosis, or falciform/seromuscular patches lead to lower PFR than suture closure alone. However, the differences are rather small, and further RCTs are needed to test these effects. Selective closure of the main pancreatic duct during stump closure may prevent severe PF.
Izvorni podaci
- DOI
- 10.1371/journal.pone.0197553
- PMID
- 29897920
- PMCID
- PMC5999073
- Provjereno
- 2026-07-26
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