Carolyn Cullinane, Michael Devine, Mohammed Alazzawi, Criostoir O Suilleabhain, Adrian O Sullivan
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引用次数: 0
摘要
背景：生长抑素类似物（SSA）对术后胰瘘（POPF）风险降低的影响缺乏清晰度，报告相互矛盾。本研究的目的是进行系统回顾和荟萃分析，以探讨SSA对POPF率的影响。方法：根据国际胰瘘研究小组（ISGPF）在2015年重新定义临床显著性胰瘘的共识，对报告与SSA使用相关的POPF的研究进行了系统回顾。主要结果是围手术期接受SSA的患者中临床相关POPF的发生率。结果：20项研究，包括6947例患者，符合纳入条件。总的来说，SSA的使用并没有显著降低发生POPF的风险（OR 0.89, 95% CI 0.66-1.20, P = 0.44, I2 = 73%）。进行亚组分析以确定SSA是否可以降低高危队列（软胰，导管2 = 73%）的POPF。此外，B级和C级POPF的亚组分析均未显示SSA有任何益处。结论：SSA预防不能降低临床相关POPR的发生率，不应常规应用于胰腺切除术。
"Somatostatin analogues do not reduce the risk of clinically relevant post-operative fistula rates in patients undergoing pancreatic surgery", a systematic review and meta-analysis.
Background: The impact of Somatostatin Analogues (SSA) on Post-Operative Pancreatic Fistula (POPF) risk reduction lacks clarity and reports are conflicting. The aim of this study was to perform a systematic review and meta-analysis to explore the effect of SSA on POPF rates.
Methods: A systematic review was performed for studies reporting POPF in relation to SSA use following the consensus by the International Study Group of Pancreatic Fistula (ISGPF) to re-define what constitutes a clinically significant POPF in 2015. The primary outcome was the incidence of clinically relevant POPF among patients who received SSA peri-operatively.
Results: Twenty studies, including 6947 patients, were eligible for inclusion. Overall, SSA use did not significantly lower the risk of developing a POPF(OR 0.89, 95 % CI 0.66-1.20, P = 0.44, I2 = 73 %). Subgroup analysis was performed to determine whether SSA could reduce POPF in high-risk cohorts (soft pancreas, duct <5 mm). SSA did not significantly reduce POPF in the five studies reporting on high-risk cohorts (OR 1.42, 95 % CI 0.60-3.37, P = 0.43, I2 = 73 %). Furthermore, subgroup analysis of both grade B and grade C POPF's did not show any benefit of SSA.
Conclusion: SSA prophylaxis does not reduce the incidence of clinically relevant POPR and should not be routinely administered for pancreatic resections.
期刊介绍：
HPB is an international forum for clinical, scientific and educational communication.
Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice.
Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice.
HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields.
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