胰头癌胰十二指肠切除并淋巴结扩大清扫术价值的系统评价

Pancreaticoduodenectomy with extended lymphadenectomy for pancreatic cancer： a meta-analysis

目的 用循证医学的方法评价胰十二指肠切除淋巴结扩大清扫术治疗胰头癌的价值和意义。方法 检索1973—2006年8月间发表的有关胰十二指肠切除淋巴结扩大清扫术治疗胰头癌效果的临床对照试验（包括随机和非随机研究）。按人选和排除标准，有8项临床试验纳入该研究，由2名评价者对入选研究中有关试验设计、研究对象的特征、研究结果等内容独立进行摘录，用RevMan4．2软件进行分析。结果 胰十二指肠切除并淋巴结扩大清扫组与标准手术组间的手术并发症、手术死亡率（RR=0．90，95％CI：0．36～2．24，P=0．83）、术后1年生存率（RR=1．10，95％CI：0．97～1．25，P=0．12）、3年生存率（RR=1．33，95％CI：0．99～1．78，P=0．06）均无显著差异，淋巴结扩大清扫对提高5年生存率有统计学意义（RR=2．19，95％CI：1.39～3．46，P〈O．01）。亚组分析显示胰十二指肠切除并淋巴结扩大清扫对提高淋巴结阳性胰头癌的术后1年生存率无统计学意义（RR=1.08，95％CI：0．88～1.32，P=0．48）。结论 胰十二指肠切除淋巴结扩大清扫治疗胰头癌是安全的，尚不能明显提高术后1年和3年生存率，能提高5年生存率。有必要在临床上进一步开展淋巴结扩大清扫范围规范统一的、足够大样本量的随机对照研究来明确淋巴结扩大清扫的价值。

Objective To determine the value of pancreaticoduodenectomy with extended lyrnphadenectorny for pancreatic cancer. Methods PubMed, EMBASE,Cochrane Library and China Biological Medicine Disk from 1973 to August 2006 were searched for articles using the MeSH headings of pancreaticoduodenectorny,lyrnph node excision and pancreas cancer. These articles are the clinical trials of comparing standard pancreaticoduodenectorny with extended lyrnphadenectorny for pancreatic cancer,including cohort and randomized controlled trials. Bibliographies of journal articles were also searched for relevant studies. The detail about the trial design, characters of the subjects, results of the studies were reviewed by two independent authors and analyzed with Revrnan 4. 2 software. Results Eight articles were enrolled into the analysis： three prospective randomized trials,one non-randomized prospective trial and four international cohort studies. Compared with standard lyrnphadenectorny,the pancreaticoduodenectorny with extended lyrnphadenectorny was not associated with significantly higher incidence of postoperative morbidity,hospital death （RR=O. 90,95% CI：0. 36-2. 24,P=0. 83）, 1-year survival rate （RR--1.10,95% CI：0.97 1.25,P=0.12） and 3-year survival rate （RR-1.33, 95% CI：0.99-1.78,P=0.06）. The extended lyrnphadenectorny also could not increase 1-year survival rate of node-positive patients by subgroup analysis （RR = 1.08,95 % CI ： 0.88- 1.32, P= 0.48）. However,it could increase the 5-year survival rate （RR=2.19,95% CI：1. 39-3.46,P〈0.01）. Conclusion Current literature suggests that addition of extended lyrnphadenectorny to pancreaticoduode- nectorny for pancreatic cancer is safe,but cannot improve long-term survival significantly. It is necessary to carry out further high-quality prospective randomized trials to determine the value of pancreati coduodenectomv with extended lvmnhadenectomv for pancreatic cancer