胰十二指肠切除术联合扩大淋巴结清扫治疗壶腹周围癌疗效的系统评价  

Standard vs extended lymphadenectomy associated with pancreaticoduodenectomy for periampullary adenocarcinoma: A meta-analysis

作　　者：陈舒婷[1] 邱建国[1] 员海超[2] 蒋辉[1] 吴泓[1] 

机构地区：[1]四川大学华西医院肝胆胰外科,四川省成都市610041 [2]四川大学华西医院泌尿外科,四川省成都市610041

出　　处：《世界华人消化杂志》2013年第34期3887-3893,共7页World Chinese Journal of Digestology

摘　　要：目的:系统评价胰十二指肠切除术联合扩大淋巴结清扫治疗壶腹周围癌的疗效及安全性.方法:计算机检索Cochrane Library andControlled Trials Registry(1991-2010)、Medline O v i d(1956-2010)、P u b M e d(1977-2010)、S c i e n c e D i r e c t(1 9 5 6-2 0 1 0)、We b o f Knowledge(1956-2010)等外文期刊,收集胰十二指肠切除术联合扩大淋巴结清扫与标准淋巴结清扫治疗壶腹周围癌的随机对照试验.数据提取和文献质量评价由两名评价员独立进行.采用Cochrane协作网专用软件RevMan5.0.22对数据进行统计分析.结果:共纳入5个临床随机双盲对照试验,合计673例患者.Meta分析结果显示:胰十二指肠切除术联合扩大淋巴结清扫使得淋巴结清除数量和手术时间增加,两组患者除了延迟胃排空发生率在扩大淋巴结清扫患者中显著增加外,其他并发症、术后死亡率以及长期生存时间方面没有显著差异.结论:尽管胰十二指肠切除术联合扩大淋巴结清扫可获得较多的淋巴结清除数量,但延长了手术时间且不能延长患者的长期生存时间,对患者的长期生存没有益处并在某种程度上可能增强手术并发症的风险.AIM： To review and evaluate the therapeutic effi- cacy of extended lymph node dissection （ELND） associated with pancreaticoduodenectomy for periampullary adenocarcinoma compared to conventional standard lymph node dissection （SLND）. METHODS： The Cochrane Library and Con- trolled Trials Registry （1991-2010）, Medline Ovid （1956-2010）, PubMed （1977-2010）, Science Direct（1956-2010）, and Web of Knowledge （1956-2010） were electronically searched for randomized clinical trials （RCTs） that compared the thera- peutic endpoints of SLND vs ELND associated with pancreaticoduodenectomy for periampul- lary adenocarcinoma patients, with English lan- guage as a limit. Meta-analysis was performed using RevMan 5.0.22 software. RESULTS： Five RCTs involving 673 patients were included for pooled analysis. Meta--analysis showed that ELND were associated with longer operative time and higher number of dissected lymph nodes than SLND. The postoperative morbidity and mortality were similar when the two groups were compared except a significant lower frequency of delayed gastric emptying in the SLND group. There was no significant differ- ence between two groups regarding long-term survival. CONCLUSION： ELND appears not to improve the long-term survival of patients with peri- ampullary cancer although a significant higher number of lymph nodes dissected were ob- served in the ELND group.

关 键 词：壶腹周围癌 胰十二指肠切除术 淋巴结清扫 系统评价 

分 类 号：R735.0[医药卫生—肿瘤]