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目的:评价剖腹胰十二指肠切除术(OPD)、腹腔镜胰十二指肠切除术(LPD)和达芬奇机器人系统辅助下胰十二指肠切除术(RPD)对患者术后发生胰瘘风险的影响。方法:以laparoscopic、pancreaticoduodenectomy、robotic、DaVinci、Whipple、complication、fistula、胰十二指肠切除、腹腔镜、机器人、术后并发症、胰瘘为检索词，检索CBM、Cochrane Library、PubMed、Embase、Web Of Science、中国知网、万方、维普等数据库，检索时限从建库至2020年8月1日。搜索关于对比OPD、LPD及RPD疗效的回顾性队列研究及随机对照研究，按照预先设定的纳入与排除标准筛选文献及评估文献质量并提取数据。基于贝叶斯框架，采用R4.0.2 、Revman 5.3及Stata 16.0软件对提取的数据进行网状Meta分析。结果:最终纳入30篇文献，共3 428例患者，其中26篇为回顾性队列研究，4篇为随机对照研究。网状Meta分析结果显示，在术后胰瘘发生率方面，LPD与OPD、LPD与RPD间的差异均无统计学意义(n OR＝0.93，95%n CI0.63～1.40n OR＝1.4，95%n CI0.87～2.20，n P值均>0.05)，而RPD的术后胰瘘发生率显著低于OPD，差异有统计学意义(n OR＝1.5，95%n CI1.1～2.1，n P<0.05)。胰瘘发生风险概率排序依次为RPD(0.00)、LPD(0.34)、OPD(0.65)，即术后胰瘘发生风险的优劣排序依次为RPD、LPD、OPD。n 结论:与OPD相比，RPD能显著降低胰十二指肠切除术后胰瘘发生风险，提高其手术质量；LPD与RPD在术后胰瘘发生方面无明显差异，二者均安全可行。“,”Objective:To evaluate the impact of laparotomy pancreatoduodenectomy (OPD), laparoscopic pancreatoduodenectomy (LPD) and Da Vinci robot assisted pancreatoduodenectomy (RPD) on the risk of pancreatic fistula in postoperative patients.Methods:The key words were laparoscopic, pancreaticoduodenectomy, robot, DaVinci, Whipple, complication, fistula, pancreaticoduodenectomy, laparoscopy, robot, postoperative complications and pancreatic fistula, and the databases of CNKI, Wanfang, VIP, CBM, Cochrane Library, PubMed, EMBASE and web of science were searched until August 1, 2020 for retrospective cohort studies and randomized controlled trials comparing the efficacy of OPD, LPD and RPD. The articles were screened according to the pre-set inclusion and exclusion criteria, and the quality of the articles was evaluated and the data were extracted. Based on Bayesian framework, R4.0.2, Revman 5.3 and Stata 16.0 software were used to analyze the extracted data for mesh meta analysis.Results:Thirty articles involving 3 428 patients were included, including 26 retrospective cohort studies and 4 randomized controlled studies. Mesh meta-analysis showed that in the incidence of pancreatic fistula, there was no significant difference between LPD and OPD, between LPD and RPD (n OR=0.93, 95%n CI 0.63-1.4; n OR=1.4, 95%n CI 0.87-2.2, n P<0.05), but the incidence of postoperative pancreatic fistula was significantly lower than that of OPD (n OR=1.5, 95%n CI 1.1-2.1, n P0.05). The risk probability of pancreatic fistula was ranked as RPD (0.00), LPD(0.34) and OPD(0.65), that is, for the risk of postoperative pancreatic fistula, the advantages and disadvantages of the three surgical methods were ranked as RPD, LPD and OPD.n Conclusions:Compared with OPD, RPD can significantly reduce the risk of pancreatic fistula after PD and improve the quality of operation; there was no significant difference between LPD and RPD in the incidence of postoperative pancreatic fistula, and both of them were safe and feasible.