腹腔镜对比开腹胰体尾切除术治疗胰腺导管腺癌的荟萃分析

Laparoscopic versus open pancreatectomy for pancreatic ductal adenocarcinoma:a meta-analysis

目的对比腹腔镜胰体尾切除术(LDP)与开腹胰体尾切除术(ODP)治疗胰腺导管腺癌的安全性和有效性。方法检索2018年2月前公开发表的比较LDP和ODP治疗胰腺癌的临床试验。按照纳入排除标准筛选文献、提取资料并评价纳入研究的质量后,采用RevMan 5.3软件进行Meta分析。结果共纳入11个对照试验。荟萃分析结果显示,与ODP组相比,LDP组术后并发症低(OR=0.67,95%CI:0.49~0.92,P<0.05)、出血量少(WMD=-260.70,95%CI:-402.40^-119.00,P<0.05)、术后住院时间短(WMD=-3.39,95%CI:-4.45^-2.32,P<0.05)、死亡率低(RD=-0.02,95%CI:-0.03^-0.01,P<0.05)。两组之间术后胰漏发生率、手术时间差异无统计学意义(OR=1.21,WMD=8.82,P均>0.05)。结论腹腔镜胰体尾切除术治疗胰腺癌安全可行,具有术中出血少、术后恢复快和并发症少等优点。

Objective To compare the safety and efficacy of laparoscopic distal pancreatectomy（LDP）and open distal pancreatectomy（ODP）in the treatment of pancreatic ductal adenocarcinoma. Methods The published clinical studies including LDP and ODP in treatment of pancreatic cancer before February 2018 were reviewed.The studies were screened according to the inclusion and exclusion criteria.After extracting data and assessing the quality of the included studies,meta-analysis was conducted using RevMan 5.3 software.Results The meta-analysis showed that the LDP in the treatment of pancreatic ductal adenocarcinoma was superior to the ODP with lower incidence of complication（OR=0.67,95% CI：0.49～0.92,P〈0.05）,less blood loss（WMD=-260.70,95% CI：-402.40～-119.00,P〈0.05）,shorter hospitalization time（WMD =-3.39,95% CI：-4.45～-2.32,P〈0.05）,and lower mortality（RD=-0.02,95% CI：-0.03～-0.01,P〈0.05）.The difference in POPF and operation time between two groups was not statistically significant （OR=1.21,WMD=8.82, P〉0.05）.Conclusion Laparoscopic appendectomy for pancreatic cancer is safe and feasible with less intraoperative hemorrhage,rapid postoperative recovery and fewer complications.