微创与开放胰十二指肠切除术治疗胰腺或壶腹周围肿瘤效果Meta分析  

Minimally invasive versus open pancreatoduodenectomy for pancreatic or periampullary tumours:a Meta-analysis

作　　者：王建晖 高翔[2] 张培荣[3] WANG Jian-hui;GAO Xiang;ZHANG Pei-rong(Weifang Medical University,Weifang 261041,China;不详)

机构地区：[1]潍坊医学院,山东潍坊261041 [2]潍坊市人民医院重症医学科,山东潍坊261041 [3]潍坊医学院附属医院,山东潍坊261041

出　　处：《中国实用外科杂志》2023年第9期1046-1055,共10页Chinese Journal of Practical Surgery

基　　金：山东省医药卫生科技发展计划项目(No.202004011537)。

摘　　要：目的 探讨微创下与开放胰十二指肠切除术治疗胰腺或壶腹周围肿瘤的安全性和有效性,并分析病人的预后。方法 潍坊医学院附属医院通过对Embase、Pub Med、Cochrane Library、Web of Science、维普数据库、CNKI和万方数据库的检索,确定所有关于比较微创与开放胰十二指肠切除术治疗胰腺或壶腹周围肿瘤的随机对照试验。对文章的相关数据进行提取,主要结果是90 d病死率、严重术后并发生症、再手术率、住院时长;次要结果包括术中失血量,手术时间,术后出血,术后胃排空延迟,术后胰漏、胆漏,入住ICU时长,再次入院率;肿瘤学结局指标包括R0切除率、淋巴结清扫数。采用Rev Man 5.4软件进行数据分析。结果 一共检索到文献9226篇,经过剔除非随机对照研究,按照纳入排除标准共筛选出4项随机对照研究,共738例病人。Meta分析结果显示腹腔镜下胰十二指肠切除术(LPD)比开放性胰十二指肠切除术(OPD)的失血量低(MD:-128.59 m L,95%CI-173.28~-83.89,P<0.00001),住院时间短(RR=-1.63;95%CI-2.71~-0.54;P=0.003),但手术时间明显延长(MD:66.78 min,95%CI 34.47~99.10,P<0.0001),差异具有统计学意义。两组病人在90 d病死率、严重术后并发症(Clavien-Dindo分级≥3级)、胰腺切除术后出血、胃排空延迟、术后胰漏、胆漏、再手术率、住ICU时间、住院时间、再入院率、R0切除率、淋巴结清扫数之间差异并无统计学意义(P值均>0.05)。结论 在目前的证据水平上,LPD和OPD的安全性相类似,其优点在于出血量低、住院时间短,除此之外,LPD并没有表现出比OPD更多的临床益处。Objective Pancreatic or periampullary neoplasms are a disease with high mortality,and pancreaticoduodenectomy is the main surgical treatment.In clinical practice,the results of minimally invasive pancreaticoduodenectomy and open pancreaticoduodenectomy have not been adequately compared,and their safety and efficacy are still controversial.Therefore,this study conducted a Meta-analysis of related randomized controlled trials(RCTs)to investigate the safety and efficacy of minimally invasive versus open pancreaticoduodenectomy for pancreatic or periampullary tumours,and to analyze the prognosis of patients.Methods We searched Embase,PubMed,Cochrane Library,Web of Science,Weipu Data,CNKI and Wanfang Data for RCTs comparing minimally invasive to OPD for adults with benign or malignant disease requiring elective pancreaticoduodenectomy.The relevant data of the article are extracted.The primary outcomes were 90-day mortality,severe postoperative complications,reoperation rate,and length of hospital stay.Secondary outcomes included intraoperative blood loss,operation time,postoperative bleeding,delayed gastric emptying,postoperative pancreatic fistula,biliary fistula,length of ICU stay,and readmission rate.Oncological outcome measures included R0 resection and number of lymph nodes dissected.Then Meta-analysis was performed using RevMan 5.4 software.Results A total of 9226 articles were retrieved.Non-rct studies were excluded,a total of four RCTs with a total of 738 patients were screened according to the inclusion and exclusion criteria.The results of Meta-analysis showed that laparoscopic pancreaticoduodenectomy(LPD)had lower blood loss(MD:-128.59 mL,95%CI-173.28 to-83.89,P<0.00001)and shorter hospital stay(RR=-1.63;95%CI:2.71~0.54;P=0.003),but the operation time was significantly prolonged(MD:66.78 min,95%CI 34.47~99.10,P<0.0001).The difference was statistically significant.There were no significant differences in mortality within 90 days,severe postoperative complications(Clavien-Dindo≥3),postoperative bleeding,del

关 键 词：胰十二指肠切除术 腹腔镜 胰腺 壶腹周围肿瘤 META分析 

分 类 号：R6[医药卫生—外科学]