Risk factors in delayed post-pancreaticoduodenectomy hemorrhage： a meta-analysis

doi:10.3969/j.issn.1009-976X.2024.06.001

Abstract

Abstract: Objective Through meta-analysis of risk factors related to delayed post-pancreaticoduodenectomy hemorrhage （DPPDH） at home and abroad, to provide theoretical basis for prevention and treatment of delayed hemorrhage after pancreaticoduodenectomy. Methods Previous studies on the risk factors of delayed hemorrhage after pancreaticoduodenectomy were searched by computer in medical literature databases, including PubMed, Cochrane Library, Embase, Web of science, CNKI, Wanfang, VIP and other resources. RevMan 5.4 and STATA were used in this meta-analysis. The heterogeneity and publication bias of the research is included in analysis to ensure the reliabity of this meta-analysis. Results A total of 16 retrospective studies were included. Meta-analysis showed thatthere was no significant differences between diabetes mellitus, hypertension, preoperative albumin, preoperative biliary drainage or not, tumor character, delayed gastric emptying and delayed hemorrhage after pancreaticoduodenectomy （P>0.05）. And the results showed that the elderly （SMD=0.16, 95%CI： 0.02-0.29, P=0.02）, male （OR=1.77, 95%CI： 1.43-2.18, P<0.001）, preoperative total bilirubin （OR=0.28, 95%CI： 0.04-0.51, P=0.02）, vascular reconstruction（OR=1.75, 95%CI： 1.08-2.84, P=0.02）, soft pancreas texture （OR=0.39, 95%CI： 0.23-0.66, P=0.0005）, pancreatic duct diameter <3 mm（OR=0.53, 95%CI： 0.35-0.81, P=0.004）, pancreatic leakage （OR=4.04, 95%CI： 3.19-5.13, P<0.001）, bile leakage （OR=4.04, 95%CI： 2.83-5.76, P<0.001） and abdominal infection （OR=6.61, 95%CI： 4.60-9.51, P<0.001） was closely related to the occurrence of delayed hemorrhage after pancreaticoduodenectomy. Conclusion There was no significant association between the DPPDH anddiabetes mellitus, hypertension, preoperative albumin, preoperative biliary drainage or not, tumor character, delayed gastric emptying. Age, gender, preoperative total bilirubin, vascular reconstruction, pancreas texture, pancreatic duct diameter, pancreatic leakage, bile leakage, abdominal infection are factors associated with DPPDH.

Key words: pancreaticoduodenectomy, delayed hemorrhage, risk fctors, meta-analysis

摘要： 目的通过Meta分析国内外胰十二指肠切除术后迟发性出血的相关危险因素,为防治术后发生迟发性出血提供理论依据。方法计算机检索医学文献库,包括PubMed、Cochrane Library、Embase、Web of science、中国知网、万方、维普及其他资源途径等检索既往关于胰十二指肠切除术后迟发性出血危险因素的相关研究。本研究采用Revman 5.4及STATA进行相关Meta分析,并分析纳入研究的异质性及发表偏倚,确保研究分析的可靠性。结果共纳入16项回顾性研究。Meta分析结果示：糖尿病、高血压病、术前白蛋白、术前是否减黄、肿瘤性质、胃排空延迟与胰十二指肠切除术后是否发生迟发性出血无明显相关性（P>0.05）。而高龄（SMD=0.16,95%CI：0.02-0.29,P=0.02）、男性（OR=1.77,95%CI：1.43-2.18,P<0.001）、术前总胆红素（OR=0.28,95%CI：0.04-0.51,P=0.02）、血管重建（OR=1.75,95%CI：1.08-2.84,P=0.02）、胰腺质地偏软（OR=0.39,95%CI：0.23-0.66,P=0.0005）、胰管直径<3 mm（OR=0.53,95%CI：0.35-0.81,P=0.004）、胰漏（OR=4.04,95%CI：3.19-5.13,P<0.001）、胆漏（OR=4.04,95%CI：2.83~5.76,P<0.001）及腹腔感染（OR=6.61,95%CI：4.60-9.51,P<0.001）与胰十二指肠切除术后迟发性出血的发生密切相关。结论胰十二指肠切除术后迟发性出血与糖尿病、高血压病、术前白蛋白、术前是否减黄、肿瘤性质、术后胃排空延迟无显著相关性。年龄、性别、术前总胆红素、血管重建、胰腺质地、胰管直径、胰漏、胆漏、腹腔感染是胰十二指肠切除术后迟发性出血的危险因素。

关键词: 胰十二指肠切除, 迟发性出血, 危险因素, Meta分析

CLC Number:

YANG Guang, WU Jian-wu, JIANG Xin-wei. Risk factors in delayed post-pancreaticoduodenectomy hemorrhage： a meta-analysis[J]. Lingnan Modern Clinics In Surgery, 2025, 24(06): 335-346.

杨光, 吴建武, 蒋新卫. 胰十二指肠切除术后迟发性出血危险因素的Meta分析[J]. 岭南现代临床外科, 2025, 24(06): 335-346.

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