ABSTRACT
Objective There have been many techniques proposed for the reconstruction of pancreatic digestive continuity to prevent fistula (PF) formation, but this is still highly debated. We carried out a systematic review and meta- analysis to determine the effectiveness of methods of anastomosis after pancreaticoduodenectomy (PD). Methods A full literature search was conducted in the Cochrane Controlled Trials Register Databases, Medline, et al.Randomized controlled trials(RCTs) were considered for inclusion. Analysis was carried out using Revman software. Results In all, 10 RCTs including a total of 1 408 patients were included, the pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) groups, duct to mucosa PJ and PJ, binding PJ and PJ, pancreatic duct without anastomosis PJ and PJ. The meta-analysis showed that the PF, postoperative complications, biliary fistula, mortality, re-operation and hospital stay were not statistically different among four methods(P>0.05).Conclusions No ideal technique of pancreatic reconstruction after PD is found to be applicable to all kinds of pancreatic remnants in this systematic review and meta-analysis.
ABSTRACT
Objective To evaluate the effct of full increase of three-dimensional conformal radiotherapy on esophageal carcinoma.Methods 86 Esophageal cancer patients which has been pathologically confirmed were randomly divided into study group and control group.The control group showed in tumor invasion scope simulator under barium meal positioning,with three fields outside irradiation;Total dose of DT with 63～70 Gy,35 times,seven weeks to complete.Study group showed that full use of additional 3D treatment planning system design individualized treatment programs,90% of the dose contains all planned target volume,future confonnal irradiation DY 44～50 Gy,after the wild-shrinkage increases to a total dose DT66～75 Gy,30 times,completed six weeks.Results The study group and the control group after radiotherapy in a local control rates were 86.4%and 64.3%(x2=4.5420,P＜0.05).Overall response rate(CR+PR)in two group were 93.2%and 76.2%(x2=3.6014,P=0.0577).Two toxicity of the difference was not significant.Conclusion The increase in full three-dimensional conformal radiotherapy of esophageal emleer in the near future is better than conventional methods.