保留十二指肠的胰头切除与保留幽门的胰十二指肠切除治疗胰头肿块型胰腺炎的Meta分析  

A meta-analysis on surgical treatments for chronic pancreatitis： duodenum-preserving pancreatic head resection versus pylorus-preserving pancreaticoduodenectomy

作　　者：汪超[1] 黄强[1] 林先盛[1] 刘臣海[1] 杨骥[1] 

机构地区：[1]安徽医科大学附属安徽省立医院胆胰外科,合肥230001

出　　处：《中华肝胆外科杂志》2015年第8期528-533,共6页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨保留十二指肠的胰头切除术（DPPHR）与保留幽门的胰十二指肠切除术（PPPD）治疗胰头肿块型胰腺炎的安全性和有效性。方法系统检索Medline、Biosis、TheCochraneLibrary、ScienceCitationIndex Database、中国生物医学文献数据库、中国期刊全文数据库、万方数据库、维普中文科技期刊数据库。选取相关临床随机对照试验，参考CochraneHandbook的偏倚风险评估工具评估偏倚风险。应用ReviewManager5．2统计软件对两类术式安全性和有效性相关参数进行统计分析。结果纳入的7篇文献共226例患者。DPPHR组与PPPD组比较，在术后总并发症发生率、术后住院时间、疼痛完全缓解率、胰漏发生率、胰腺外分泌不足以及术后5—7、14—15年随访症状评分等方面差异无统计学意义（P〉0．05）。在手术时间、术中用血量、胃排空延迟发生率、工作恢复、体重恢复、术后1—2年总体生活质量评分、术后5—7年术后疼痛发生率、身体机能评分、术后14～15年随访症状评分等方面DPPHR组优于PPPD组，差异有统计学意义（P〈0．05）。结论DPPHR在减少术中用血、缩短手术时间、胃排空延迟、工作恢复、体重恢复及身体机能等方面优于PPPD，有利于提高胰头肿块型慢性胰腺炎患者的生活质量。Objective To compare the safety and effectiveness of duodenum-preserving pancreatic head resection （DPPHR） with pylorus-preserving pancreaticoduodenectomy （PPPD） in the treatment of chronic pancreatitis with a pancreatic head mass. Methods Medline, Biosis, Cochrane Library, Science Citation Index Database, CBM Database, Wan Fang and CNKI were searched systematically. The bias risk of the included trials was assessed according to the assessing tools as suggested by the Cochrane Handbook. Review Manage 5.2 was used to perform the statistical analysis. Results 7 RCTs with 226 patients were in- cluded in the meta-analysis which showed that there were no significant differences between PPPD and DPPHR in overall postoperative morbidity, postoperative hospital stay, complete pain relief, pancreatic fistu- la, exocrine insufficiency, symptom score at 5 to 7-year follow-up, and quality of life score at 14 to 15-year follow-up （P 〉 0.05 ）. While DPPHR had significant superiorities in operation time, blood replacement, de- layed gastric emptying, occupational rehabilitation after the operations, weight gain, quality of life score at 1 to 2-year follow-up, symptom score at 5 to 7-year follow-up, and physical functioning score at 14 to 15-year follow-up. Conclusions DPPHR is more favourable than PPPD in reducing the use of blood replacement, shortening operation time, delayed gastric emptying, occupational rehabilitation after the operations, weight gain, physical functioning, and in improving quality of life of patients.

关 键 词：慢性胰腺炎 保留十二指肠的胰头切除术 保留幽门的胰十二指肠切除术 荟萃分析 

分 类 号：R657.5[医药卫生—外科学]