胰十二指肠切除术的开腹和微创手术方法疗效的比较  

Efficacy and safety of minimally invasive pancreaticoduodenectomy vs open pancreaticoduodenectomy: A systematic review and metaanalysis

作　　者：李瑞阳[1] 黄强[1] 林先盛[1] 刘臣海[1] 杨骥[1] 胡俊[1] 汪超[1] 

机构地区：[1]安徽医科大学附属安徽省立医院胆胰外科安徽省重点实验室,安徽省合肥市230001

出　　处：《世界华人消化杂志》2014年第24期3690-3698,共9页World Chinese Journal of Digestology

摘　　要：目的:探讨胰十二指肠切除术(pancreatic o d u o d e n e c t o m y,P D)的开腹行P D(o p e n pancreaticoduodenectomy,OPD)和微创手术(minimally invasive pancreaticoduodenectomy,MIPD)的疗效的对比.方法:计算机检索在2014-03-31前在Medline、EMBASE、Science Direct、Springer link公开发关于PD的开腹和微创手术方法的疗效的文献,按纳入排除标准由2位研究者独立进行文献筛选、资料提取和方法学质量评价后,采用RevMan5.2.7软件进行Meta分析.结果:共纳入8篇文献进行系统评价,包含MIPD 204例,OPD 419例.Meta分析结果显示:MIPD和OPD在术后围手术期并发症发生率、胰瘘发生率、术后胃排空障碍、胆瘘、术后出血、再手术、病死率及R0切除方面的差异无统计学意义(P>0.05);在手术时间、术中出血量及术后住院时间的差异有统计学意义(P<0.05).结论:MIPD能减少PD术后住院时间和术中出血量,且围手术期并发症和术后病理诊断与传统的OPD基本无差异,可以作为胰十二指肠切除术的常规术式,值得临床的推广,未来仍需要大样本、多中心、前瞻性随机对照的高质量的临床研究来进一步验证.AIM： To evaluate the safety and efficacy betweenminimally invasive pancreaticoduodenectomyand open pancreaticoduodenectomy. METHODS： Medline, EMBASE, Science Directand Springer link databases（till March 31, 2014）were searched by computer to collect the articlesthat compared the efficacy and safety of mini-mally invasive pancreaticoduodenectomy vsopen pancreaticoduodenectomy. The trials wereselected according to the inclusive and exclusivecriteria, and the quality of the included trialswas assessed. The data were extracted and ana-lyzed using RevMan 5.2.7 software. RESULTS： A total of 8 articles were included in the present meta-analysis. The meta-analysis showed that there were no significant differ-ences in perioperative complications, mortal-ity, pancreatic fistula, delayed gastric empty, postoperative hemorrhage, reoperation, mortal-ity or R0 resection rate between the minimally invasive pancreaticoduodenectomy group and open pancreaticoduodenectomy group（P〈0.05）. There were significant differences in operative time, estimated blood loss and length of hospital stays between the two groups（P〈0.05）. CONCLUSION： This meta-analysis indicates that minimally invasive pancreaticoduodenec-tomy is associated with shorter hospital stay and less estimated blood loss compared with open surgery, although there are no differences in preoperational complications or postopera-tive pathological diagnosis. Minimally invasive approach can be a reasonable alternative to laparotomy pancreaticoduodenectomy with po-tential advantages. Nevertheless, future large-volume, well-designed randomized control trials with extensive follow-up are awaited to confirm and update the findings of this analysis.

关 键 词：胰十二指肠切除术 腹腔镜 机器人 微创技术 系统评价 

分 类 号：R656[医药卫生—外科学]