腹腔镜与开腹胰体尾切除术并发症的Meta分析

Complications following laparoscopic versus open distal pancreatectomy： a meta-analysis

目的系统评价腹腔镜与开腹行胰体尾切除术的安全性。方法于Cochranelibrary、MEDLINE、EMbase、Google学术、CNKI等数据库检索比较腹腔镜与开腹胰体尾切除术的随机对照试验（RCT）、临床对照试验（CCT）或回顾性病例对照研究。按照纳入和排除标准筛选文献以及进行Jadad质量评价后，再采用Cochrane协作网专用软件RevMan5．0对数据进行Meta分析。结果最终纳入21篇文献，共2797例。其中1150例行腹腔镜胰体尾切除术（LDP），l647例行开腹胰体尾切除术（ODP）。Meta分析结果显示：（1）术后总并发症发生率：20个试验（n=2597）表明，LDP与ODP的术后总并发症发生率差异有统计学意义，LDP组为33．90％低于ODP组的46．80％[RR=0．76，95％凹（0．69～0．84），P〈0．01]；（2）围手术期病死率：8个试验（rt=1869）表明，LDP（4／703）与ODP（18／1166）的围手术期病死率差异无统计学意义[RR=0．51，95％CI（0．21～1．24），P〉0．05]；（3）胰漏发生率：20个试验（rt=2757）表明，LDP（168／1132）与ODP（281／1625）两者胰瘘发生率差异无统计学意义[RR：0．89，95％CI（0．75～1．06），P〉0．05]；（4）切口感染率：11个试验（n：l840）表明，LDP与ODP的切口感染率差异有统计学意义，LDP为3．24％低于ODP的10．85％[RR=0．34，95％CI（0．23～0．52），P〈0．01]；（5）肺部并发症发生率、腹腔感染率、尿路感染率、术后出血率、假性囊肿发生率、肠梗阻发生率和腹水发生率两组差异均无统计学意义。结论腹腔镜胰体尾切除术较传统开腹手术具有术后总并发症发生率低、切口感染少等优点，且术后病死率、胰瘘发生率与开腹手术差异无统计学意义，是安全、可行的手术方式。

Objective To systematically evaluate the safety of laparoscopic distal pancreatectomy （LDP） compared with open distal pancreatectomy （ODP）. Methods Databases including Cochrane libra- ry, MEDLINE, EMbase, Google Scholar and Chinese National Knowledge Infrastructure were searched to enroll randomized clinical trials （RCT）, controlled clinical trials （CCT） or retrospective case-control stu- dies to compare LDP with ODP. All articles received quality assessment according to the inclusion and exclu- sion criteria, then the selected indices were analyzed using the Review Manager Version 5.0 software （ The Cochrane Collaboration, Oxford, United Kingdom）. Results 21 manuscripts with a total of 2 797 patients were enrolled. 1 150 patients underwent LDP and the remaining 1 647 patients underwent ODP. In 20 stu- dies （ n = 2 597）, the total postoperative complication rates were 33.90% for the LDP group versus 46. 80% for the ODP group [ RR = 0. 76, 95% CI（O. 69 ~ 0. 84）, P 〈 0. 01 I. In 8 studies （ n = 1 869） there was no significant difference [RR =0. 51, 95% CI（O. 21 - 1.24）, P 〉0. 05] in the perioperative mortality between LDP （4/703） and ODP （ 18/1 166）. In 20 studies （n =2 757） there was no significant difference [RR = 0. 89, 95% CI（O. 75 - 1.06）, P 〉0. 05] in the pancreatic fistula rate between LDP （ 168/1 132） and ODP （281/1 625）. In 11 studies （ n = 1 840） the wound infection rate of LDP （3.24%） was significantly lower than ODP （ 10. 85% ） [ RR = 0. 34, 95% CI（0. 23 - 0. 52）, P 〈 0. 01 ]. No significance was found between the two groups in the rates of pulmonary complications, peritoneal infection, urinary tract infection, posto- perative bleeding, pseudocyst formation, intestinal obstruction and ascites formation between LDP and ODP. Conclusions When compared with the traditional open procedure, LDP has the advantages of significantly lower rates of postoperative complication and wound infection. There were no significant differences in postoperative mortality, and pancreatic fistula rate between LDP and ODP. This meta-analysis suggests that LDP is a safe and feasible operative method.