Risk Factors For Post-Pancreaticoduodenectomy Hemorrhage:a Meta-Analysis

[Objective]This article is written to review the development of pancreaticoduodenectomy and summarize its currently application situation.We analyse the risk factors associated with post-pancreaticoduodenectomy hemorrhage (PPDH) by Meta-Analysis.To make a better understanding of risk factors of PPDH and provide statistical evidence for the clinically precaution of PPDH.[Methods]A systematic search of MEDLINE, Cochrane Library, EMBASE, CBM,CNKI, VIP and WanFang databases, up to December1,2012,was performed to identify articles about risk factors for PPDH,which were published in the last decade. According to the standard provided by Cochrane Collaboration, two investigators extracted data from retrieved studies independently and graded the articles by Newcastle-Ottawa Scale. Controversies during process above were resolved by discussion. The meta-analysis was performed by RevMan5.1recommended by Cochrane Handbook for Systematic Reviews of Interventions. After the identification and treatment of heterogeneity, odds ratio (OR) standardized mean difference(SMD),weighted mean difference (WMD)and their respective95%CI (confidence interval) were then estimated separately per each outcome for combine data. Finally forest plots were drawn to display the results of statistic analysis.The causes of heterogeneity among studies were analyzed and discussed and sensitivity analysis should be undertaken to evaluate the stability and reliability of the results. [Results]Seventeen studies were collected, involving421cases in case group(PPDH group) and2834cases in control group(Non-PPDH group).The results of meta-analysis showed that there were no significant differences in age, blood loss, the preoperative level of alanine aminotransferase(ALT), hypertension complication, diabetes mellitus complication, properties of tumor(P>0.05).The incidence rate of PPDH in male patients was significantly higher than that of female patients,[OR=1.36;95%CI:1.02-1.82;P=0.04];The preoperative level of bilirubin, surgical time of PPDH group was significantly more than those of Non-PPDH group,[OR=0.42; P=0.04];Patients with larger tumor or pancreatic fistula or infection of peritoneal cavity have a higher incidence rate of PPDH,(tumor diameter:OR=5.36;95%CI:2.97-9.66;P<0.00001; Pancreatic fistula:OR=6.32;95%CI:4.09-9.76;P<0.00001; infection of peritoneal cavity:OR=4.95;95%CI:3.57-6.87;P<0.00001)。[Conclusions]Gender, preoperative level of bilirubin, surgical time,tumor diameter, postoperative pancreatic fistula and infection of peritoneal cavity are factors associated with PPDH.There was no significant association between the PPDH and age, blood loss, the preoperative level of alanine aminotransferase(ALT), hypertension complication, diabetes mellitus complication, properties of tumor.