Evidence Based Medical Research On The Relationship Between Pancreaticojejunostomy And Pancreatic Fistula After Pancreaticoduodenectomy

Objective: The object of this study is to analyze the efficacy and safety of two methods of pancreaticojejunostomy and pancreatic duct stent drainage after pancreaticoduodenectomy in prevention of pancreatic fistula.Finally,providing a reference for clinical application.Methods: Randomized controlled trials comparing outcomes of duct-to-mucosa and invagination pancreaticojejunostomy,external and internal pancreatic stenting with pancreaticojejunostomy following pancreaticoduodenectomy were retrieved through Datebases PubMed,The Cochrane Library,Web of Science and Wang Fang,The primary endpoint was postoperative pancreatic fistula rate.The statistical analysis was done by RevMan5.3 soft ware.Results: This study mainly consists of two parts.Comparion of clinlcal efficacy of duct-to-mucosa and invagination pancreaticojejunostomy in prevention of pancreatic fistula: a meta analysis(Part 1),Comparion of clinlcal efficacy of external and internal stent drainage with pancreaticojejunostomy in prevention of pancreatic fistula: a meta analysis(Part 2).A total of 10 RCTs were included In the first part,including1092 patients(540 cases in duct-to-Mucosa PJ)and(552 cases in invaginated pancreaticojejunostomy),the result showed that: No statistical difference were found in postoperative pancreatic fistula(OR=0.95,95%CI:0.69~1.30,P=0.73),grade(A/B/C)pancreatic fistula,pancreatic fistula with soft texture of the pancreas(OR=1.04,95%CI:0.67~1.62,P=0.85),morbidity(OR=0.98,95%CI:0.75~1.29,P=0.90)between duct-to-mucosa and invaginated pancreatojejunostomy.There were also no significant differences in haemorrhage,delayed gastric emptying,intra-abdominal collection,reoperation,mortality and length of stay between the two groups.A total of 5 RCTs were included In the second part,including 868 patients(435 patients in the external stent group)and(433 patients in the internal stent group),the result showed that:No statistical difference were found in postoperative pancreatic fistula(OR=0.80,95%CI:0.59~1.10,P=0.17),grade(A/B/C)pancreatic fistula between the external and internal stent group.For patient with the main pancreatic duct diameter less than 3mm,the rate of pancreatic fistula in the pancreatic duct external stent drainage group was lower than that in the pancreatic duct internal stent drainage group(OR=0.33,95%CI:0.18~0.63,P=0.01).For patient with the main pancreatic duct diameter>3mm,there is not difference between two groups(OR=0.65,95%CI:0.22~1.88,P=0.42).Conclusion: 1.Based on the present research results,Duct-to-Mucosa and invaginated pancreaticojejunostomy after pancreaticoduodenectomy are safe and convenient pancreatic juice outflow tract reconstruction procedure.2.Pancreatic duct external stent drainage is superior to pancreatic duct internal stent drainage regarding pancreatic fistula rate in small pancreat duct(?3mm).The two methods that are stuied reveal no significant difference regarding the rate of POPF in pancreat duct(>3mm).