中段胰腺切除术与远端胰腺切除术术后并发症及远期生存质量比较的meta分析  

The comparison of central pancreatectomy versus distal pancreatectomy in complications and postoperative long term survival quality: a Meta analysis

作　　者：彭斌 黄强 林先盛 汪超 杨骥 

机构地区：[1]安徽医科大学附属省立医院胆胰外科,合肥肝胆胰安徽省重点实验室,合肥230001

出　　处：《肝胆外科杂志》2016年第5期358-364,共7页Journal of Hepatobiliary Surgery

摘　　要：目的探讨中段胰腺切除术和远端胰腺切除术术后并发症的差异和远期生存质量的区别。方法计算机检索在2015年12月31日前在Medline、Embase、Webofscience、Sciencedirect、Springerlink、Cochranecenter数据库上公开发表的关于CP和DP手术术式选择的随机对照试验或严格设计的临床对照试验。按纳入排除标准由2位研究者独立进行文献筛选（PRISMA标准）、资料提取和方法学质量评价后，采用RevMan5．2软件进行Meta分析。结果共纳入文献10篇，共包含病例数797例，其中行CP例数为355例，行DP例数为442例。Meta分析表明：在术后并发症方面：CP和DP在术后胰瘘[RR=1．46，95％ci（1．07～2．10），P=0．02]、手术时间[WMD33．40，95％CI（16．36，50．43），P=0．0001]；术中失血量[WMD-129．06，95％CI（-233．28，-24．84），P=0．02]和术后总体并发症[RR1．30，95％CI（1．05，1．62），P=0．02]的差异有统计学意义（P〈0．05）。而在术后的住院时间、再手术、出血和病死率的差异无统计学意义（P〉0．05）。远期胰腺内分泌功能障碍[RR=1．46，95％CI（1．07～2．10），P〈0．05]、胰腺外分泌功能不全[RR=0．61，95％CI（0．44～0．86），P=0．004]的差异有统计学意义。结论中段胰腺切除术由于在术后胰腺内分泌功能障碍和外分泌功能不全低于远端胰腺切除术，值得临床上推广，但需要严格把握手术指征和术后管理，但仍需多中心、大样本、前瞻I生RCT研究验证。Objective To evaluate the peri-operative complications and the long term pancreatic endocrine and endocrine functions between the Central panereateetomy and distal pancreatectomy. Methods Medline ,Embase ,Web of science ,Science direct, Springer link, Cochrane center were retrieved by computer before 31 st December 2015 to collect the RCT articles or clinical trials of the comparison between the CP and DP. The quality of the included trials was assessed according to the inclusive and exclusive criteria（ the PRISMA statement） by 2 researchers independently, then the data were extracted and analyzed by using RevMan 5.2 software. Results A total of 10 retro prospective clinical trial articles which involving 797 patents were included in the study. The number of patients undergoing the CP was 355 and DP was 442. There were significant differences（ P 〈 0. 05 ） in the pancreatic fistula[ RR = 1.46,95% CI（ 1.07 - 2. 10） ,P = 0.02 ], operative time [ WMD 33.40,95% CI（ 16. 36,50.43 ） ,P = 0. 0001 ], the blood loss [ WMD - 129.06, 95% CI（ - 233.28, - 24. 84） ,P = 0. 02 ], and the overall postoperative complications [ RR 1.30,95 % CI（ 1.05,1.62 ）, P = 0. 02 ] between the CP and DP. And no signifieances between CP and DP in the length of hospital stay, reoperation, bleeding and mortality （P 〉0. 05 ）. During the follow-up period, the patients after DP were more likely to suffer pancreatic endocrine impairment [ RR = 1.46,95% CI（ 1.07 -2. 10） ,P 〈0. 05 ] and exocrine insufficiency [ RR =0.61,95% CI（0. 44 -0. 86） ,P =0. 004]. Conclusion CP was still an acceptable and feasible procedure and worth of clinical application. But still need large, multicenter prospective ran- domized controlled trias.

关 键 词：远端胰腺切除术 中段胰腺切除术 生存质量 系统评价 

分 类 号：R659[医药卫生—外科学]