胰十二指肠切除术标准与扩大淋巴结清扫疗效对比的Meta分析  

Comparison of Standard and Extended Lymph Node Dissection in Pancreaticoduodenectomy: A Meta-Analysis

作　　者：陈庆[1,2,3,4] 刘畅 王槐志[1,2,3,4] 

机构地区：[1]重庆医科大学,重庆 [2]中国科学院重庆绿色智能技术研究院,重庆 [3]中国科学院大学重庆学院,重庆 [4]重庆市人民医院肝胆胰腺外科,重庆

出　　处：《临床医学进展》2023年第12期20456-20470,共15页Advances in Clinical Medicine

摘　　要：目的:探讨胰十二指肠切除术中行标准清扫淋巴结与扩大淋巴结清扫的安全性与有效性。方法:检索PubMed、Cochrane Library、Embase、SinoMed、中国知网、万方数据库、维普数据库的临床随机对照研究,检索时间为建库时间至2023年4月1日,使用RevMan 5.4.1软件进行统计分析。结果:共计7篇文献、827例患者纳入分析,Meta分析提示EPD组较之于SPD组手术切缘阴性率更高(OR: 0.58, 95% CI: 0.38~0.89, P = 0.01)、淋巴结清扫数量更多(WMD: −10.13, 95% CI: −12.98~−7.28, P 0.05)。结论:EPD组在术后5年生存期、死亡率、术后并发症、无病生存期等与SPD组差异无统计学意义,EPD手术时间更长,可以认为EPD较之于SPD无明显优势,不建议常规行EPD。Objective: To investigate the safety and efficacy of standard lymphadenectomy and extended lym-phadenectomy in pancreaticoduodenectomy. Methods: PubMed, Cochrane Library, Embase, Si-noMed, CNKI, Wanfang database, and VIP database were searched for randomized controlled trials (RCTs) published from the establishment of the database to April 1, 2023. RevMan 5.4.1 software was used for statistical analysis. Results: A total of 7 articles with 827 patients were included in the analysis. The meta-analysis showed that EPD group had a higher rate of negative surgical margins (OR: 0.58, 95% CI: 0.38~0.89, P = 0.01) and more lymph nodes retrieved (WMD: −10.13, 95% CI: −12.98~−7.28, P = 0.0001), longer operation time (WMD: −46.11, 95% CI: −69.54~ −22.69, P = 0.0001). There were no significant differences in intraoperative blood loss, intraoperative blood transfusion, length of postoperative hospital stay, 5-year survival, disease-free survival, postopera-tive complications, and postoperative mortality between the two groups (P > 0.05). Conclusions: There were no significant differences in 5-year survival, mortality, postoperative complications and disease-free survival between the two groups, but the operation time of EPD was longer. EPD has no obvious advantage over SPD, and it is not recommended to perform EPD routine operation.

关 键 词：胰十二指肠切除术 淋巴结清扫 R0切除率 术后生存期 

分 类 号：R73[医药卫生—肿瘤]