腹腔镜和开腹行胰十二指肠切除手术疗效的Meta分析

The effect of laparoscopy pancreaticoduodenectomy versus open pancreaticoduodenectomy:A Meta-analysis

目的系统评价腹腔镜与传统开腹行胰十二指肠切除术的近期疗效及安全性,为临床治疗提供客观依据。方法通过计算机检索CNKI、WangFang和PubMed（1990~2013.11）,收集腹腔镜和传统开腹胰十二指肠切除术疗效和安全性比较的非随机临床对照试验研究。采用Cochrane协作网专用软件Rev Man 5.0对数据进行Meta分析。结果共纳入5篇非随机临床对照试验,合计471例患者。Meta分析结果 ：①手术时间：两组比较差异有显著性[MD=105.73,95%CI（16.03,195.44）,P=0.02];②术中出血量：两组比较差异有显著性[MD=-446.08,95%CI（-845.35,-46.80）,P=0.03];③再次手术率：两组比较差异无显著性[RR=0.8,95%CI（0.28,2.34）,P=0.69];④住院时间：两组比较差异无显著性[MD=-2.16,95%CI（-4.90,0.58）,P=0.12];⑤围手术期死亡率：两组比较差异有显著性[RR=0.76,95%CI（0.27,2.29）,P=0.66];⑥胰漏发生率：两组比较差异无显著性[RR=0.95,95%CI（0.57,1.56）,P=0.83];⑦切口感染率：两组比较差异有显著性[RR=0.45,95%CI（0.22,0.92）,P=0.03];⑧延迟性胃排空率：两组比较差异无显著性[RR=1.05,95%CI（0.56,1.97）,P=0.88]。结论与开腹组相比,腹腔镜组具有术中出血少和切口感染率低,但手术时间较长,而再次手术率、住院时间、、围手术期死亡率、胰漏发生率和延迟性胃排空率无差别,因此该手术可以在有条件且有经验基础的大型医院开展。

[Objective]To evaluate the clinical effect and safety of the effect of laparoscopy pancreaticoduodenectomy versus open ancreaticoduodenectomy, and to provide an objective choice for clinical treatment.[Methods]The following databases as CNKI, WangFang and PubMed（from 1990 to 2013.11） were searched electronically, and traced related references. All randomized controlled trials and non-random controlled trials on comparing laparoscopy pancreaticoduodenectomy with open ancreaticoduodenectomy were collected. The Cochrane network RevMan 5.0 software was used for Meta-analysis. [Results]5 nonrandomized controlled clinical trials with 471 patients were included. The meta-analysis detected no statistically significant difference between the two groups in reoperation rate [RR= 0.8, 95% CI（0.28, 2.34）, P =0.69], the hospitalization duration [MD=-2.16,95% CI（-4.90, 0.58）, P =0.12], perioperative mortality rate [RR=0.76, 95% CI（0.27, 2.29）, P =0.66], the incidence of pancreatic leak [RR=0.95, 95% CI（0.57,1.56）, P = 0.83], delayed gastric emptying rate [RR=1.05, 95%CI（0.56,1.97）, P =0.88]. The laparoscopic resection surgery significantly reduced the amount of bleeding [MD=-446.08, 95%CI（-845.35,-46.80）, P =0.03], and the postoperative wound infection [RR =0.45, 95% CI（0.22, 0.92）, P =0.03], except the operative time [MD =105.73, 95% CI（16.03, 195.44）, P =0.02]. [Conclusion]According to the research, we can see the laparoscopic resection surgery is better than the conventional surgery in the safety and efficiency, except the operative time. Therefore, this procedure can be implemented in some large-scale hospitals.