预防性胃肠转流在晚期壶腹周围癌外科治疗中的价值  

Evaluation of prophylactic gastroenterostomy in late periampullary carcinoma

作　　者：付金强[1] 雷正明[2] 

机构地区：[1]四川省乐山市人民医院普外科,614000 [2]泸州医学院附属医院肝胆外科,四川646000

出　　处：《中华普通外科学文献（电子版）》2007年第2期67-74,共8页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的通过Meta分析,探讨预防性胃肠转流在晚期壶腹周围癌外科治疗中的价值。方法通过MEDLINE,EMBASE,OVID,HIGHWIRE以及维普资讯网等数据库检索已发表和未发表的相关文献。选择治疗组为预防性胃肠转流和胆肠吻合术双旁路治疗晚期壶腹周围癌,对照组为单纯胆肠吻合术治疗晚期壶腹周围癌,由2位评价者,按纳入标准入选,主要对术后十二指肠及幽门梗阻发生率进行Meta分析,其次是术后并发症发生率、手术死亡率、术后平均生存期。结果共18个文献资料(3个RCT和15个NRCT)纳入本课题研究。在治疗晚期壶腹周围癌方面,预防性胃肠转流和胆肠吻合术双旁路联合术式与单纯胆肠吻合手术比较,术后十二指肠及幽门梗阻RR为0.18(0.11,0.27),P<0.01,RD为-0.20(-0.27,-0.13),P<0.01。术后并发症发生率RR=1.09,P=0.45,RD为0.03(-0.04,0.09),P=0.43。手术死亡率RR为1.01(0.76,1.34),P=0.96,RD为0.00(-0.04,0.04),P=0.95。术后平均生存期,两项研究显示前种手术方法的术后生存时间较后者长。结论在晚期壶腹周围癌的外科治疗上,预防性胃肠转流和胆肠吻合术双旁路联合术式相对于单纯胆肠吻合手术治疗能较大幅度降低患者术后十二指肠及幽门梗阻发生率,延长患者术后生存时间,不增加患者术后并发症发生率和手术死亡率。同时为其他辅助治疗提供时机和营养保证。Objective To evalute prophylactic gastroenterostomy in patients with late periampullary carcinoma(PAC) using a meta-analysis. Methods MEDLINE, EMBASE and PUBMED searchs were supplemented by information from trial registers. Controlled trials for prophylactic gastroenterostomy concomitant with bilio-enteric bypass and bilio-enteric by-pass alone in inoperable periampullary carcinoma. A quantitative meta-analysis using updated information based on inclusion criterion from all available randomized controlled trials and non-randomized controlled trials were carried out by two reviewers. The pirmany meta-analysis was based on gastric outlet obstruction rate. The second was postoperative complications, operative death rate and survival time. Result The meta-analysis included 3 randomized controlled trials and 15non- randomized controlled trials. In late periampullary carcinoma, there was a significant decrement for two by-pass procedures in gastric outlet obstruction rate(RR=0.18,P<0.01, RR, relative risk meanes risk in the prophylactic gastroenterostomy concomitant with bilio-enteric bypass group risk in the bilio-enteric bypass alone group; RD=-0.20, P<0.01, RD, rate difference meanes risk in the two by-pass procedures drecreases risk in the bilio-enteric bypass alone procedures, Post-operation complications rate (RR=1.09, P=0.45; RD=0.03, P=0.43); Operative death rate (RR=1.01,P=0.96; RD=0.00,P=0.95). Two research items of three research items show the postoperative survival time two by-pass procedures were longer than bile by-pass only. Conclusion Comparing with bilioenteric by-pass only in inoperable periampullary carcinoma. The prophylactic gastroenterostomy concomitant with bilioenteric by-pass decrease significantly occurring rate of gastric outlet obstruction, prolong postoperative survival time, but did not increase postoperative complications, operative death rate. It can increase chance for other treatment and nutrition.

关 键 词：晚期胰头癌 晚期壶腹周围癌 胆肠吻合 胆肠转流 预防性胃肠吻合 预防性胃肠转流 META分析 随机对照实验 

分 类 号：R735.0[医药卫生—肿瘤]