SSPPD和PPPD的疗效比较  

Comparison of clinical effect between SSPPD and PPPD: a meta-analysis

作　　者：张明杰[1] 王怀涛[1] 谭晓冬[1] 刘畅[1] 高峰[1] 张小薄[1] 周磊[1] 杨一帆[1] 黄冠龙[1] 

机构地区：[1]中国医科大学附属盛京医院胰腺甲状腺外科,沈阳110004

出　　处：《中国普外基础与临床杂志》2017年第3期286-296,共11页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的系统评价保留近全胃胰十二指肠切除术(SSPPD)与保留幽门的胰十二指肠切除术(PPPD)的疗效差异,重点分析比较术后胃排空障碍(DGE)发生率的差异,以探讨SSPPD的价值和意义。方法计算机检索Cochrane Library、Pub Med数据库、Embase数据库、Web of Science、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普和万方数据库中关于SSPPD与PPPD疗效比较的文献。按Cochrane系统评价的方法评价纳入研究的质量,采用Rev Man 5.3软件对数据进行meta分析。首先比较所有纳入研究中SSPPD组和PPPD组的疗效差异,再比较符合国际胰腺外科研究组(International Study Group of Pancreatic Surgery,ISGPS)中DGE标准的研究中SSPPD组和PPPD组总DGE发生率和临床性DGE(包括B级和C级)发生率的差异。结果共纳入10篇文献、804例患者,其中SSPPD组433例,PPPD组371例。纳入所有研究进行meta分析,结果显示,SSPPD组与PPPD组的DGE发生率〔OR=0.33,95%CI为(0.17,0.63),P=0.000 9〕、术后留置胃管时间〔MD=–2.65,95%CI为(–4.49,–0.80),P=0.005〕和开始进流食时间〔MD=–4.13,95%CI为(–7.35,–0.91),P=0.01〕比较差异均有统计学意义,SSPPD组的术后DGE发生率较低,留置胃管时间和开始进流食的时间较短;但2组患者的手术时间、术中失血量、开始进普食时间、重新留置胃管率、胰瘘发生率、腹腔感染发生率、二次手术率、切口感染发生率、术后出血发生率、围手术期死亡率及住院时间比较差异均无统计学意义(P>0.05)。将符合ISGPS DGE标准的8项研究进行meta分析,结果显示,SSPPD组和PPPD组患者的总DGE发生率〔OR=0.31,95%CI为(0.15,0.65),P=0.002〕和临床性DGE发生率〔OR=0.13,95%CI为(0.05,0.40),P=0.000 3〕比较差异均有统计学意义,SSPPD组的DGE发生率和临床性DGE均较低。结论 SSPPD术后的DGE发生率要比PPPD低,同时SSPPD术后留置胃管时间和开始进流食时间要比PPPD短,而其他方�Objective This study was conducted to evaluate and analyze the clinical effect between subtotal stomach-preserving pancreaticoduodenectomy （SSPPD） and pylorus-preserving pancreaticoduodenectomy （PPPD）, especially compare the incidences of delayed gastric emptying （DGE） between them. Methods The documents about SSPPD and PPPD were searched in Cochrane Library, PubMed database, Embase database, Web of Science, Chinese biomedicine database, CNKI database, VIP database, and WanFang database. The quality of included studies was assessed according to the Cochrane systematic review methods, and statistical analysis of data was performed by using RevMan 5.3 software. Firstly, comparison of incidence of DGE and other effective indexes between SSPPD group and PPPD group was performed by enrolling all included studies, whether met the DGE standards of International Study Group of Pancreatic Surgery （ISGPS） or not, and then comparison of incidence of DGE and clinical DGE was performed by enrolling included studies that met the DGE standards of ISGPS. Results Ten studies were included, with a total of 804 patients, in which, 433 cases underwent SSPPD and 371 cases underwent PPPD. The results of meta-analysis indicated that, in all the included studies, the total incidence ofDGE （ OR = 0.33, 95% CI is （0.17, 0.63）, P = 0.000 9 ）, and the time ofnasogastric tube （ MD = -2.65, 95% CI is （-4.49, -0.80）, P = 0.005 ）, and time of stared liquid diet （MD = -4.13, 95% CI is （-7.35, -0.91）, P = 0.01 ） showed significant differences. The total incidence of DGE, the time of nasogastric tube, and time of stared liquid diet were less in SSPPD group. But there was no significant difference between the SSPPD group and PPPD group in operating time, intraoperative blood loss, time of started solid diet, hospital stay, and incidences of reinsertion of nasogastric tube, pancreatic fistula, intra-abdominal abscess, reoperation, wound infection, postoperative hemorrhage, and mortality （P〉0.05）. In the

关 键 词：胃排空障碍 保留近全胃胰十二指肠切除术 保留幽门的胰十二指肠切除术 META分析 

分 类 号：R656[医药卫生—外科学]