保留十二指肠在慢性胰腺炎外科治疗中临床价值的Meta分析  

Duodenum-preserving pancreatic head resection versus pancreaticoduodenectomy for surgical treatment of chronic pancreatitis:a meta-analysis

作　　者：殷子[1] 孙健[1] 徐康[1] 肖治宇[1] 叶华[1] 张建龙[1] 张贺云[1] 毛凯[1] 唐启彬[1] 王捷[1] 

机构地区：[1]中山大学孙逸仙纪念医院华南肝胆医院,广州510120

出　　处：《消化肿瘤杂志（电子版）》2011年第4期217-223,共7页Journal of Digestive Oncology(Electronic Version)

摘　　要：目的系统评价保留十二指肠在慢性胰腺炎外科治疗中的价值。方法检索数据库包括Pubmed、Embase、OVID,Cochrane临床对照试验中心数据库(CENTRAL)和中国生物文献数据库(CBM)等及其它人工辅助文献搜索。遵循Cochrane Handbook 5.0和纽卡斯尔-渥太华评价原则评价纳入研究的质量。采用RevMan 5.1软件进行统计学处理。系统评价保留十二指肠的胰头切除(DPPHR)相对于胰十二指肠切除(PD)治疗慢性胰腺炎的价值。结果共10篇文献,663例患者纳入分析。术后疼痛缓解(RR=1.08;95%CI:0.97-1.20;P=0.15)、术后并发症(RR=0.67;95%CI:0.44-1.03;P=0.07)以及术后并发胰腺内分泌功能障碍(RR=0.42;95%CI:0.15-1.22;P=0.11),DPPHR术式优于PD,但差异未达统计学意义。DPPHR术后并发胰腺外分泌功能障碍发生率显著低于PD(RR=0.25;95%CI:0.15-0.43;P<0.01)。术后胃排空延迟发生率,DPPHR显著低于PD(RR=0.11;95%CI:0.04-0.35;P=0.01)。手术时间、术中出血和住院天数,DPPHR显著少于PD。术后营养状态(术后体重增加情况)和恢复正常工作,DPPHR显著优于PD。患者术后短期与长期的生存质量,DPPHR显著优于PD。结论保留十二指肠的胰头切除与胰十二指肠切除在术后疼痛缓解和术后并发症方面同样安全有效,然而保留十二指肠能显著降低胃排空延迟和术后胰腺外分泌功能障碍的发生率,减少手术时间和住院天数,提高患者营养状态和生活质量。Objective To systematically evaluate the clinical outcomes of duodenum-preserving pancreatic head resection(DPPHR) versus pancreaticoduodenectomy(PD) by means of postoperative morbidity,functional outcomes and quality of life.Methods Randomized controlled trials(RCTs) and non-RCTs were identified by means of MEDLINE,EMBASE,OVID,Cochrane Controlled Trials Register databases,and Chinese Biomedical Database.The quality of each trial was assessed and relevant data were extracted from qualified trials.RevMan 5.1 was used to perform meta-analysis.Results Ten articles were included in the meta-analysis and 663 patients were enrolled in the study..DPPHR was better in postoperative pain relief,overall morbidity and postoperative endocrine insufficiency than PD,but no significant differences were found.The incidences of postoperative exocrine insufficiency(RR=0.25;95% CI: 0.15-0.43;P<0.01) and delayed gastric emptying(RR=0.11;95% CI: 0.04-0.35;P=0.01) were significantly lower in DPPHR group than those in PD group.Intra-operative blood loss,hospital stay,postoperative weight gain and occupational rehabilitation,and short and long-term quality of life were significantly improved in DPPHR group than those in DP group.Conclusions DPPHR and PD seem to be equally safe and effective in terms of postoperative pain relief and overall morbidity.However,this meta-analysis indicates that DPPHR is superior to PD in the treatment of chronic pancreatitis with regard to decreased incidences of postoperative exocrine insufficiency and delayed gastric emptying,improvement of intra-operative blood loss,hospital stay,postoperative weight gain,and quality of life.

关 键 词：保留十二指肠的胰头切除 胰十二指肠切除 慢性胰腺炎 META分析 

分 类 号：R657.51[医药卫生—外科学]