联合腹腔干切除胰体尾癌根治术治疗局部进展期胰体尾癌疗效与安全性的Meta分析  

Meta-analysis of efficacy and safety of distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body/tail cancer

作　　者：黄婉霞 杨忠 王尚 刘露 彭灵智 张永斌[2] 刘天祥[2] 邱志胜[2] 姚继彬[2] 达明绪 HUANG Wanxia;YANG Zhong;WANG Shang;LIU Lu;PENG Lingzhi;ZHANG Yongbin;LIU Tianxiang;QIU Zhisheng;YAO Jibin;DA Mingxu(College of Clinical Medicine,Ningxia Medical University,Yinchuan 750004,China;Department of Surgical Oncology,Gansu Provincial Peoples Hospital,Lanzhou 730000,China;College of Clinical Medicine,Gansu University of Chinese Medicine,Lanzhou 730000,China)

机构地区：[1]宁夏医科大学临床医学院,宁夏银川750004 [2]甘肃省人民医院肿瘤外科,甘肃兰州730000 [3]甘肃中医药大学临床医学院,甘肃兰州730000

出　　处：《中国普通外科杂志》2020年第3期291-300,共10页China Journal of General Surgery

基　　金：甘肃省卫生行业科研计划资助项目(GSWSKY-2019-04);甘肃省人民医院院内科研基金资助项目(18GSSY5-9)。

摘　　要：背景与目的:联合腹腔干切除胰体尾癌根治术(DP-CAR)是一种复杂的外科手术,与传统胰体尾癌根治术(DP)相比,在治疗局部进展期胰体尾癌时,具有许多潜在的优势,如可以提高R0切除率,减轻疼痛,改善生活质量,延长生存期等。然而,DP-CAR的临床疗效和安全性仍存在诸多争议。本Meta分析目的是评价DP-CAR治疗局部进展期胰体尾癌的临床疗效和安全性。方法:通过相关检索词在多个国内外数据库中检索各数据库自建库至2019年6月的中英文文献,严格按照纳入及排除标准对文献进行筛选后,提取研究数据,并对纳入的文献进行质量评价,用RevMan 5.3软件对提取的数据进行Meta分析。结果:共纳入了13篇文献,均为非随机对照研究,其中1篇为前瞻性研究,12篇为回顾性研究;2篇为多中心研究,11篇为单中心研究。共涉及1219例患者,其中DP-CAR组237例,DP组982例。Meta分析结果显示,DP-CAR组与DP组在术后1、2、3年生存率(RR=0.86,95%CI=0.63~1.18,P=0.36;RR=0.70,95%CI=0.45~1.10,P=0.12;RR=0.93,95%CI=0.51~1.70,P=0.82),术后胰瘘的发生率(RR=1.12,95%CI=0.92~1.36,P=0.27)差异均无统计学意义,但DP-CAR组R0切除率明显低于DP组(RR=0.78,95%CI=0.68~0.90,P=0.0006),术后近期病死率(RR=4.91,95%CI=1.90~12.67,P=0.001)、再次手术率(RR=10.96,95%CI=3.27~36.74,P=0.0001)、临床相关性胰瘘(RR=1.57,95%CI=1.19~2.08,P=0.002)和胃排空延迟(RR=2.78,95%CI=1.33~5.81,P=0.007)的发生率均高于DP组,且DP-CAR组手术时间(MD=91.98,95%CI=60.63~123.34,P<0.00001)长于DP组、失血量(MD=275.33,95%CI=135.95~414.71,P=0.0001)大于DP组。结论:DP-CAR对于局部进展期胰体尾癌患者没有明显的生存获益,且其增加术后近期病死率、再次手术率及术后并发症的发生率,故应慎重选择该术式。Background and Aims:Distal pancreatectomy with en bloc celiac axis resection(DP-CAR),a complex surgery,has many potential advantages over the conventional distal pancreatectomy(DP)in the treatment of locally advanced pancreatic body/tail cancer,such as increasing R0 resection rate,reducing pain,improving quality of life,and prolonging survival.However,the clinical efficacy and safety of DP-CAR remain controversial.The purpose of this Meta-analysis was to evaluate the clinical efficacy and safety of DP-CAR in the treatment of locally advanced pancreatic body/tail cancer.Methods:Literature searches,in both Chinese and English,were performed in several national and international databases from their inception to June 2019 by using relevant search terms.After literature screening strictly according to the inclusion and exclusion criteria,study data extraction and quality assessment of the included studies,Meta-analysis was conducted by RevMan 5.3 software.Results:A total 13 studies were finally selected,all of which were non-randomized controlled studies,including one prospective study,and 12 retrospective studies;2 multi-center studies and 11 single-center studies.A total of1219 patients were involved,with 237 cases in the DP-CAR group and 982 cases in DP group.The results of Meta-analysis showed that there were no significant differences between DP-CAR group and DP group in 1-,2-and 3-year survival rates(RR=0.86,95%CI=0.63–1.18,P=0.36;RR=0.70,95%CI=0.45–1.10,P=0.12;RR=0.93,95%CI=0.51–1.70,P=0.82)as well as the incidence of postoperative pancreatic fistula(RR=1.12,95%CI=0.92–1.36,P=0.27),while the R0 resection rate was lower(RR=0.78,95%CI=0.68–0.90,P=0.0006)and the incidence rates of early postoperative death(RR=4.91,95%CI=1.90–12.67,P=0.001),reoperation(RR=10.96,95%CI=3.27–36.74,P=0.0001),clinically relevant pancreatic fistula(RR=1.57,95%CI=1.19–2.08,P=0.002)and delayed gastric emptying(RR=2.78,95%CI=1.33–5.81,P=0.007)were significantly higher in DP-CAR group than those in DP group,further,the ope

关 键 词：胰腺肿瘤 胰腺切除术/方法 腹腔动脉 META分析 

分 类 号：R735.9[医药卫生—肿瘤]