腹腔镜与开腹胰体尾切除术疗效比较的Meta分析

Laparoscopic versus open distal pancreatectomy for pancreatic disease： a meta analysis

目的用Meta分析方法，系统评价腹腔镜胰体尾切除（LDP）与开腹胰体尾切除术（ODP）的疗效。方法计算机检索Cochrane图书馆、MEDLINE、EMBase等数据库，查找2006年1月至2012年12月发表的有关对比分析LDP与ODP疗效的随机对照试验文献。按照纳入与排除标准选择文献、提取资料、评价质量后，采用RevMan5．0软件进行Meta分析。结果共有14篇研究纳入分析，包括1417例患者，其中LDP组520例，ODP组897例。分析显示：手术时间、保脾率LDP组大于ODP组，差异有统计学意义[（均数差-273．10，95％CI-354．39～-191．81，P〈0．01）、（OR2．42，95％CI1．78～3．30，P％0．01）]；术中失血量、禁食时间、住院时间LDP组小于ODP组，差异有统计学意义[（均数差-273．10，95％CI-354．39～-191．81，P〈0．01）；（均数差-1．78，95％CI-2．36～-1．20，P〈0．01）；（均数差-3．15，95％CI-3．97～-2．33，P〈0．01）]；输血率、胰瘘发生率、死亡率两组差异无统计学意义。结论LDP安全可行。与常规开腹手术相比虽然LDP手术时间较长，但在保留脾脏、减少失血量、缩短禁食时间及住院时间方面具有优势。

Objective To evaluate the clinical effectiveness of laparoscopic （LDP） versus open distal pancreatectomy （ODP） using meta-analysis. Methods Comprehensive literature search was conducted on articles only in English published from 2006 to 2012 on MEDLINE, EMbase, Cochrane Central Registry of Controlled Trials to compare LDP with ODP for Pancreatic disease. Data were ex- tracted and evaluated by two reviewers independently. The quality of the included trials was evalua- ted. Meta-analyses were conducted using the Cochrane CollaborationPs RevMan 5.1 software. Results Fourteen controlled clinical trials （n= 1417） were included. The LDP group was significantly longer than the ODP group in operation time, and was significantly larger in the number of patients with spleen preservation [（MD-273. 10, 95% CI -354.39 --191. 081, P〈0.01）, （OR 2.42, 95% CI 1.78-3.30, P〈0.01） respectively]. The LDP group was significantly less than the ODP group in in- traoperative blood loss, time to oral intake, and length of hospital stay [（MD-- 273.10, 95% CI --354.39---191.81, P〈0.01）, （MD--1.78, 95% CI --2.36---1.20, P〈0.01）, （MD--3.15, 95% CI -- 3.97-- 2.33, P〈0.01） respectively]. There were no significant differences in blood transfusion, pancreatic fistula rate, and mortality between the two groups. Conclusions LDP is feasi- ble and safe in treating pancreatic disease. When compared with ODP, LDP has the advantages of hav ing less intraoperative blood loss, quicker recovery and more patients with spleen preservation.