胰十二指肠联合全系膜切除术与胰十二指肠切除术治疗胰头癌及壶腹周围癌效果比较的Meta分析

Clinical effect of pancreaticoduodenectomy with total mesopancreas excision versus traditional pancreaticoduodenectomy in treatment of pancreatic head carcinoma and periampullary cancer:A Meta-analysis

目的比较胰十二指肠联合全系膜切除术(TMpE)和胰十二指肠切除术(PD)治疗胰头癌及壶腹周围癌的安全性及有效性。方法计算机检索PubMed、Web of Science、Cochrane Library、中国生物医学文献数据库、中国知网数据库、万方数据库、维普数据库中2007年1月-2020年1月公开发表的有关TMpE与PD治疗胰头癌及壶腹周围癌效果对比研究的所有中英文文献,对纳入的研究进行质量评价,采用RevMan5.3软件进行Meta分析。结果经筛选后纳入5项回顾性队列研究,共358例患者,其中TMpE组188例,PD组170例。TMpE组较PD组胰瘘发生率增加[比值比(OR)=1.69,95%CI(95%CI):1.03~2.78,P=0.04],但两组术后总体并发症发生率比较,差异无统计学意义(OR=1.51,95%CI:0.76~2.98,P=0.24)。此外,TMpE提高了R0切除率(OR=2.89,95%CI:1.30~6.43,P=0.009)、淋巴结清扫数量[均数差(MD)=5.14,95%CI:4.16~6.13,P<0.001]及术后1年生存率(OR=2.60,95%CI:1.45~4.69,P=0.001),且没有增加手术时间(MD=7.74,95%CI:-42.84~58.33,P=0.76)、术中失血量(MD=-45.89,95%CI:-198.19~106.41,P=0.55)、术后住院时间(MD=-4.62,95%CI:-16.60~7.36,P=0.45)。结论TMpE治疗胰头癌及壶腹周围癌是安全可行的,且具有更高的R0切除率及术后1年生存率等优势,有望成为治疗胰头癌及壶腹周围癌的首选方法。

Objective To investigate the safety and clinical effect of pancreaticoduodenectomy with total mesopancreas excision(TMpE)versus traditional pancreaticoduodenectomy(PD)in the treatment of pancreatic head carcinoma and periampullary cancer.Methods PubMed,Web of Science,Cochrane Library,CBM,CNKI,Wanfang Data,and VIP were searched for the Chinese and English articles on the clinical effect of TMpE and PD in the treatment of pancreatic head carcinoma and periampullary cancer published from January 2007 to February 2020.Quality assessment was performed for the articles included,and Revman 5.3 software was used to perform the Meta-analysis.Results Five retrospective cohort studies were included after screening,with a total of 358 patients,among whom 188 underwent TMpE and 170 underwent PD.The results of the meta-analysis showed that compared with the PD group,the TMpE group had a significant increase in the incidence rate of pancreatic fistula(odds ratio[OR]=1.69,95%confidence interval[CI]:1.03-2.78,P=0.04),while there was no significant difference in the incidence rate of postoperative complications between the two groups(OR=1.51,95%CI:0.76-2.98,P=0.24).In addition,TMpE improved R0 resection rate(OR=2.89,95%CI:1.30-6.43,P=0.009),number of dissected lymph nodes(mean difference[MD]=5.14,95%CI:4.16-6.13,P<0.001),and 1-year survival rate after surgery(OR=2.60,95%CI:1.45-4.69,P=0.001),without increasing the time of operation(MD=7.74,95%CI:-42.84 to 58.33,P=0.76),intraoperative blood loss(MD=-45.89,95%CI:-198.19 to 106.41,P=0.55),and the length of postoperative hospital stay(MD=-4.62,95%CI:-16.60 to 7.36,P=0.45).Conclusion TMpE is safe and feasible in the treatment of pancreatic head carcinoma and periampullary cancer and has the advantages of high R0 resection rate and 1-year survival rate after surgery,and therefore,it may become a preferred treatment method for pancreatic head carcinoma and periampullary cancer.