胰十二指肠切除术与保留十二指肠的胰头切除术治疗慢性胰腺炎胰头病变的meta分析  

Pancreatoduodenectomy and duodenum-preserving pancreatic head resection for pancreatic head lesions in chronic pancreatitis:a meta-analysis

作　　者：刘东方 王连敏[1] 王滔[1] 苏琨[1] 马朝宇 吴涛[1] LIU Dongfang;WANG Lianmin;WANG Tao;SU Kun;MA Chaoyu;WU Tao(The Fourth Ward of Hepatobiliary and Pancreatic Surgery,The Second Affiliated Hospital of Kunming Medical University,Kunming,Yunnan 650106,China)

机构地区：[1]昆明医科大学第二附属医院肝胆胰外科四病区,昆明650106

出　　处：《重庆医学》2023年第19期2990-2997,共8页Chongqing medicine

基　　金：中国科学院遗传资源与进化国家重点实验室开放课题资助项目(GREKF21-11)。

摘　　要：目的比较保留十二指肠的胰头切除术(DPPHR)与胰十二指肠切除术(PD)的疗效及安全性。方法检索PubMed、Cochrane Library、Web of Science、EMBASE等医学数据库中比较DPPHR与PD治疗慢性胰腺炎的对照试验[包括随机对照试验(RCT)和非RCT],检索时间为1990年1月至2022年9月。提取的数据分别由两位研究者独立使用Stata15.1进行数据分析。结果根据纳入标准,最终纳入个17研究。其中包含5项RCT,3项前瞻性非RCT,9项回顾性研究。17项研究中,共1332例接受手术治疗的患者被纳入评估,包括652例接受PD/保留幽门的胰十二指肠切除(PPPD)的患者(PD组)和700例接受DPPHR的患者(DPPHR组)。DPPHR组与PD组在术后疼痛缓解率(OR=1.29,95%CI:0.88~1.90,P=0.198)、术后并发症发生率(OR=0.68,95%CI:0.45~1.03,P=0.068)和术后新发糖尿病发生率(OR=0.48,95%CI:0.22~1.01,P=0.054)方面差异无统计学意义。在术后新发外分泌功能不全发生率(OR=0.54,95%CI:0.38~0.78,P=0.001)、术中出血量(MD=-288.66 mL,95%CI:-468.57~-108.76 mL,P=0.002)、手术时间(MD=-128.55 min,95%CI:-179.52~-77.58 min,P<0.001)和住院时间(MD=-3.67 d,95%CI:-4.48~-2.86 d,P<0.001)方面,DPPHR组优于PD组。根据Beger术和Frey术的手术方法进行亚组分析,Beger组、Frey组与PD组在疼痛缓解率[Beger组vs.PD组(OR=1.21,95%CI:0.53~2.79,P=0.652),Frey组vs.PD组(OR=1.18,95%CI:0.48~2.91,P=0.711)]和新发外分泌功能不全发生率[Beger组vs.PD组(OR=1.57,95%CI:0.30~8.25,P=0.595),Frey组vs.PD组(OR=0.45,95%CI:0.45~1.31,P=0.142)]方面差异无统计学意义。与PD组比较,Beger组、Frey组的患者术后新发糖尿病发生率明显降低[Beger组vs.PD组(OR=0.07,95%CI:0.01~0.44,P=0.005),Frey组vs.PD组(OR=0.21,95%CI:0.07~0.62,P=0.005)]。结论DPPHR治疗慢性胰腺炎安全有效,在术后新发外分泌功能不全、术中出血量、手术时间、住院时间方面具有一定优势。Objective To compare the efficacy and safety of pancreatectomy with duodenum-preserving pancreatic head resection(DPPHR)and pancreatoduodenectomy(PD).Methods Medical databases such as PubMed,Cochrane Library,Web of Science,EMBASE,etc.were searched,and the controlled trials of DPPHR and PD in the treatment of chronic pancreatitis[including randomized controlled trial(RCT)and non-RCT]were compared.The retrieval time was from January 1990 to September 2022.The extracted data were independently analyzed by two researchers using Stata15.1.Results According to the inclusion criteria,a total of 17 studies were finally included.Among them,there were 5 RCTs,3 prospective non-RCTs and 9 retrospective studies.In 17 studies,a total of 1332 patients who underwent surgery were included in the evaluati on,including 652 patients who received PD/PPPD(the PD group)and 700 patients who received DPPH R(the DPPHR group).The postoperative pain relief(OR=1.29,95%CI:0.88-1.90,P=0.198),postoperative complications(OR=0.68,95%CI:0.45-1.03,P=0.068)and postoperative new-onset diabetes mellitus(OR=0.48,95%CI:0.22-1.01,P=0.054)were observed in the DPPHR group and the PD group.After operation,in terms of new exocrine dysfunction(OR=0.54,95%CI:0.38-0.78,P=0.001),intraoperative blood loss(MD=-288.66 mL,95%CI:-468.57 to-108.76 mL,P=0.002),operation time(MD=-128.55 min,95%CI:-179.52 to-77.58 min,P<0.001)and hospitalization time(MD=-3.67 d,95%CI:-4.48 to-2.86 d,P<0.001),the DPPHR group was better than the PD group.According to the subgroup analysis of Beger operation and Frey operation,there was no significant difference in pain relief[the Beger group vs.the PD group(OR=1.21,95%CI:0.53-2.79,P=0.652),the Frey group vs.the PD group(OR=1.18,95%CI:0.48-2.91,P=0.711)]and exocrine dysfunction[the Beger group vs.the PD group(OR=1.57,95%CI:0.30-8.25,P=0.595),the Frey group vs.The PD group(OR=0.45,95%CI:0.45-1.31,P=0.142)].Compared with the PD group,the incidence of postoperative diabetes in the Beger group and the Frey group was significantly lower[the Bege

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

分 类 号：R657[医药卫生—外科学]