胰腺中段与胰腺体尾切除:保留胰腺内外分泌功能的Meta分析

Clinical efficacy of central pancreatectomy and distal pancreatectomy: a Meta-analysis of the reserved endocrine and exocrine functions of the pancreas

背景:胰腺中段切除是针对胰腺颈部或体部等中间部分肿瘤的一种术式,相对于扩大的胰头切除和扩大的胰体尾切除,可以更多的保留正常胰腺,不切除邻近脏器,减少术后胰腺内外分泌不足的发生率。目的:系统评价胰腺中段切除与胰腺体尾切除的临床疗效。方法:计算机检索中英文数据库,对纳入的15篇临床对照试验使用Rev Ma5.2软件进行系统评价。结果与结论:纳入胰腺中段切除组(436例),胰体尾切除组(643例),共1 079例。Meta分析显示,胰腺中段切除后的胰瘘发生率、并发症发生率均显著高于胰体尾切除组;胰腺中段切除后内分泌功能不足及外分泌功能不足均显著低于胰体尾切除组;胰腺中段切除手术时间[SMD:59.23,95%CI:22.41-96.05,P<0.01]和住院时间均长于胰体尾切除组[SMD:7.01,95%CI:1.94-12.09,P<0.01]。分析结果提示,胰腺中段切除虽然早期并发症的发生率较高,但临床上是可以接受的,胰腺中段切除可能是保留胰腺内外分泌功能的合理手术方式。

BACKGROUND：Central pancreatectomy is a surgical treatment for tumors at the neck or the middle part of the pancreas, which can reserve more normal pancreas, not cut adjacent organs, and reduce the incidence of postoperative internal and external pancreatic secretion deficiency with respect to the expanded proximal and distal pancreatectomy. OBJECTIVE： To systematicaly evaluate the clinical efficacy of the central pancreatectomy and distal pancreatectomy. METHODS： A computer-based search of Chinese and English databases was performed, and then 15 controled clinical trials were included and systematicaly evaluated using RevMa5.2 software. RESULTS AND CONCLUSION： Totaly 1 079 cases were included in this study, which consisted of 436 central pancreatectomy cases and 643 distal pancreatectomy cases. Meta-analysis showed that compared with the distal pancreatectomy group, the incidences of postoperative pancreatic fistula and complications were significantly higher, the risk of postoperative endocrine and exocrine insufficiency were significantly lower, while the surgical time （SMD： 59.23, 95%CI： 22.41-96.05, P 〈 0.01） and hospital stays （SMD： 7.01, 95%CI： 1.94-12.09,P〈 0.01） were longer in the central pancreatectomy group. These findings indicate that although the central pancreatectomy has a high postoperative complication incidence, it can be accepted clinicaly, which may be a reasonable operation method to preserve pancreatic exocrine and endocrine function.