目的 探讨胰十二指肠切除术后感染并发症发生的危险因素.方法 收集2005年1月至2016年9月间PubMed、中国知网、万方等数据库公开发表的有关胰十二指肠切除术后感染并发症危险因素的文献,运用固定或随机模型对各个因素进行合并分析.结果 共纳入9项研究、1386例胰十二指肠切除术患者.Meta分析结果显示,术后感染组患者血清白蛋白水平低于术后非感染组(WMD=-3.56,95%CI:-6.01,-1.10,P=0.005);术后感染组手术时间长于非感染组(WMD=37.65,95%CI:20.81~54.49,P<0.0001);围手术期输血的患者术后感染率高于未输血的患者(OR=1.62,95%CI:1.15~2.28,P=0.006);术后发生胰瘘的患者术后感染率高于无胰瘘的患者(OR=4.96,95%CI:2.68~9.18,P<0.00001).术前胆道引流(OR=1.15,95%CI:0.86~1.55,P=0.34)、术中出血量(WMD=35.34,95%CI:-18.37~89.04,P=0.20)、术前总胆红素水平(WMD=-0.16,95%CI:-1.12~0.81,P=0.75)、是否合并糖尿病(OR=1.06,95%CI:0.59~1.91,P=0.85)等因素在两组间无统计学差异(P>0.05).结论 低白蛋白水平、手术时间长、输血以及术后胰瘘是胰十二指肠切除术后感染的危险因素,而术前胆道引流、术中出血量、术前胆红素水平、是否合并糖尿病与术后感染并发症无明显相关性.%Objective To investigate the risk factors of postoperative infectious complications (PIC) af-ter pancreatoduodenectomy by evidence-based medicine. Methods The fixed-effects or random-effects model was performed on risk factors of PIC after pancreatoduodenectomy in papers published between Jan. 2005 and Sep. 2016 by searching the PubMed, CNKI and Wanfang Data. Results Nine studies involv-ing 1386 patients were included in this Meta-analysis. The level of serum albumin was significantly lower in the PIC group than that in the non-PIC group (WMD=3.56, 95%CI: -6.01~-1.10, P=0.005); Opera-tion time in PIC group was longer than that in the non-PIC group (WMD=37.65, 95%CI: 20.81~54.49, P<0.0001); Patients with blood transfusion had a higher incidence of PIC than those without transfusion (OR=1.62, 95%CI: 1.15~2.28, P=0.006); patients with postoperative pancreatic fistula had a higher inci-dence of PIC than those without pancreatic fistula (OR=4.96, 95%CI: 2.68~9.18, P<0.00001). Other fac-tors such as preoperative biliary drainage (OR=1.15, 95%CI: 0.86~1.55, P=0.34), intraoperative blood loss (WMD=35.34, 95%CI: -18.37~89.04, P=0.20), preoperative total bilirubin level (WMD=-0.16, 95%CI: -1.12~0.81, P=0.75) and whether combined with diabetes mellitus or not (OR=1.06, 95%CI: 0.59~1.91, P=0.85) had no significant difference between the two groups ( >0.05). Conclusion A lower level of se-rum albumin, longer operation time, blood transfusion and postoperative pancreatic fistula are risk factors for PIC after pancreatoduodenectomy. And preoperative biliary drainage, intraoperative blood loss, preoperative total bilirubin level and whether combined with diabetes mellitus or not are not obviously correlated with PIC.
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