中国普外基础与临床杂志

中国普外基础与临床杂志

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全腹腔镜胰十二指肠切除术与传统胰十二指肠切除术比较的非 RCT 研究的 meta 分析

蒋康怡 , 高峰畏 , 雷泽华 , 付金强 , 杜波 , 王志旭 , 谢青云 , 周泉宇 , 薛谦 , 赵欣

乐山市人民医院肝胆胰脾外科（四川乐山 614000）

收稿日期: 2018-12-19;  修回日期:2019-02-24; 

通讯作者: 雷泽华, Email: leitsehua@126.com

Total laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy: a meta-analysis based on non-RCT studies

JIANG Kangyi , GAO Fengwei , LEI Zehua , FU Jinqiang , DU Bo , WANG Zhixu , XIE Qingyun , ZHOU Quanyu , XUE Qian , ZHAO Xin

Department of Hepatobiliary Pancreatic and Splenic Surgery, The People's Hospital of Leshan, Leshan, Sichuan 614000, P. R. China

Corresponding Author: LEI Zehua, Email: leitsehua@126.com

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目的系统性评估比较全腹腔镜胰十二指肠切除术（TLPD）与传统胰十二指肠切除术（OPD）2 种术式的可行性和安全性，为临床决策提供线索。方法系统检索相关数据库的相关文献，包括 The Cochrane Library、Medline Database、SCI、中国生物医学文献数据库（CBM）、维普中文科技期刊数据库（VIP）、中国期刊全文数据库（CNKI）、万方数据库（WanFang Data）等。采用 Review Manager 5.3 软件进行 meta 分析。结果共纳入 13 篇单中心回顾性病例对照研究，共计 808 例患者，其中 TLPD 组 401 例，OPD 组 407 例。TLPD 组与 OPD 组的术后总并发症发生率、ClavienⅢ级以上并发症发生率、术后胰瘘发生率、B/C 级胰瘘发生率、术后胆汁漏发生率、术后出血发生率、术后肺部感染发生率、术后胃排空延迟发生率、围手术期二次手术率、围手术期死亡率、R0 切除率及淋巴结清扫数目比较差异均无统计学意义（P>0.05）。TLPD 组的手术时间长于 OPD 组（P<0.05），但术中出血量、术中输血率、术后住院时间、术后首次排气时间、术后首次进食时间及术后首次下床活动时间均优于 OPD 组（P<0.05）。结论相较于 OPD 术，TLPD 术是安全可行的，虽然 TLPD 的手术时间相对长于 OPD 术，但在减少术中出血、缩短住院时间、术后饮食恢复、活动恢复等方面优于传统开放手术。

ObjectiveThis meta-analysis aimed to systematically evaluate the feasibility and the safety of total laparoscopic pancreatoduodenectomy (TLPD) by comparing it with open pancreatoduodenectomy (OPD).MethodsWe searched the relative domestic and international data bases systematically, such as The Cochrane Library, Medline Database, SCI, CBM, VIP-data, CNKI-data, and WanFang Data. We selected case control studies or cohort studies, and used the Review Manager 5.3 to perform statistical analysis.ResultsIn total, thirteen single-center retrospective case-control studies were included, totally 808 patients involved, and there were 401 cases in the TLPD group and 407 cases in the OPD group. There was no significant difference in terms of the cumulative morbidity, incidence of the Clavien Ⅲ-Ⅴ complication, pancreatic fistula, B/C pancreatic fistula, biliary fistula, postoperative hemorrhage, pulmonary infection, and gastric emptying delay, as well as the ratio of secondary operation, mortality of perioperative period, the ration of R0 resection, and the number of lymph nodes dissected between the 2 groups (P>0.05). Although the operation time was significant longer, TLPD had significant superiority in terms of the amount of bleeding and blood transfusion during operation, the hospital stays after operation, the bowel function recovery time, the time to restart eating, and the time to reactivate (P<0.05).ConclusionIn terms of the relative complications and the parameters of oncology such as the ration of R0 resection, the number of lymph nodes dissected, both of the procedures are safe and feasible, while TLPD is more favorable to control operative bleeding and accelerate rehabilitation.

关键词: 腹腔镜胰十二指肠切除术; 胰十二指肠切除术; meta 分析

Key words: laparoscopic pancreaticoduodenectomy; open pancreaticoduodenectomy; meta-analysis

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