ABSTRACT
<p><b>OBJECTIVE</b>To investigate different types of anastomosis and reconstruction techniques after pancreaticodudenectomy with meat-analysis.</p><p><b>METHODS</b>Systematically literature search was performed through Wanfang, PubMed, EMBASE, Web of Science and Cochrane Library database without restriction to regions, publication types, or languages. A total of 17 randomized controlled trials met the criteria and were evaluated by Jadad scale. Fixed and random-effects models were used to measure the pooled estimates, including pancreatic fistula, bile leakage, hemorrhage, delay gastric emptying(DGE), mortality, reoperation.</p><p><b>RESULTS</b>Meta analysis revealed that patients undergoing pancreaticogastrostomy had a lower incidence of pancreatic fistula and bile leakage(OR=0.60, 95%CI:0.44-0.82, P=0.001; OR=0.33, 95%CI:0.13-0.82, P=0.02) as compared to pancreaticojejunostomy. In pancreaticoenterostomy group, pancreatic duct-mucosa pancreaticoenterostomy had no significant differences with traditional end-to-end anastomosis in terms of overall postoperative morbidity, and development of postoperative pancreatic fistula, reoperation, perioperative death. External stent placement drainage group had a lower postoperative overall complication rate and incidence of pancreatic fistula, especially the II(-III( grade pancreatic fistula, and a shorter hospital stay than non-stent drainage group(all P<0.05).</p><p><b>CONCLUSIONS</b>Pancreaticogastrostomy should be recommended as digestive tract reconstruction after pancreaticodudenectomy and assistant external stent drainage is also necessary.</p>
Subject(s)
Humans , Anastomosis, Surgical , Drainage , Gastrointestinal Diseases , General Surgery , Pancreas , Pancreaticojejunostomy , Postoperative Complications , Postoperative Period , Randomized Controlled Trials as Topic , Plastic Surgery Procedures , Reoperation , StentsABSTRACT
Objective To investigate the clinical value of nutritional risk screening 2002(NRS2002)and malnutritional universal screening tools(MUST)in the preoperative nutrition risk evaluation of patients with gastric cancer.Methods The preoperative nutritional risk of 3 14 patients who had been admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2004 to December 2007 was assessed by subjective global assessment(SGA),NRS 2002 and M UST,and the influence of nutritional risk on the incidence of postoperative complications and hospital stay was investigated.All data were analyzed by Wilcoxon test,Kappa test and Logistics regression analysis.Results Compared with SGA,the sensitivity,specificity,positive predicting value and negative predicting value were 86.7%,74.2%,86.9% and 73.8% for NRS2002,and were 73.1%,70.6%,74.8% and 68.7% for MUST.Compared with MUST,NRS2002 had a higher consistency with SGA(K_(NRS2002)=0.601,K_(MUST)=0.436).Logistic regression analysis revealed that patients with higher MUST or NRS2002 score had higher incidence of postoperative complications and longer hospital stay.In the aspect of hospital stay,the relative risk of MUST was 2.517,which was lower than 3.426 of NRS2002.The relative risk of MUST was 0.529,which was lower than 0.642 of NRS2002 in the aspect of incidence of postoperative complications.Conclusions NRS2002 and MUST are suitable for preoperative nutritional risk screening of patients with gastric cancer,and the score of NRS2002 or MUST is associated with the incidence of postoperative complications and length of hospital stay.However,NRS2002 is more accurate than MUST in the reflection of nutritional risk of patients with gastric cancer.