肝胰十二指肠切除术治疗胆囊癌疗效的系统评价

Hepatopancreatoduodenectomy for gallbladder cancer:a systematic review and single rate meta analysis

目的系统评价肝胰十二指肠切除术治疗胆囊癌的疗效。方法检索中国知网、万方数据、PubMed、Embase等数据库关于肝胰十二指肠切除治疗胆囊癌的随机对照试验(RCT)、非随机对照研究、非随机实验性研究、病例对照研究、队列研究、案例系列研究等,各数据库检索时间均由建库至2019年12月。由两位学者按照纳入与排除标准筛选文献和提取资料,采用Stata软件进行Meta分析。结果最终纳入16篇文献,包括205例病人。结果显示:(1)1、2、3、5年生存合并率分别为56.3%、26.4%、9.3%、6.6%。(2)R0亚组分析:通过合并率来看R0切除与非R0切除1、2年生存率基本相同,但R0切除的5年生存率比非R0切除高出很多。(3)病理Ⅳ、Ⅴ亚组分析,差异无统计学意义。(4)总的复发率分析,手术复发合并率为71.2%;亚组分析示复发率差异无统计学意义。(5)围手术期并发症发生率及死亡率均较高,并发症多为胰瘘、腹腔感染、肝衰竭等,而发生围手术期死亡的原因不尽相同。结论肝胰十二指肠切除术治疗胆囊癌总体有一定价值,上述结论尚需进一步开展RCT研究来进一步验证。

Objective To systematically evaluate the efficacy of hepatopancreatoduodenectomy(HPD)in the treatment of gallbladder cancer.Methods The databases of CNKI,Wanfang,PubMed and Embase were searched for randomized controlled trials(RCTs),non-randomized controlled studies,non-randomized experimental studies,case-control studies,cohort studies and case series studies on HPD treatment of gallbladder cancer.The search time of each database was from inception to December 2019.Two scholars screened the literatures and extracted the data according to the inclusion and exclusion criteria,and Stata software was used for meta-analysis.Results 16 articles were finally included,involving 205 patients.The results showed that:(1)The combined survival rates at 1,2,3 and 5 years were 56.3%,26.4%,9.3%and 6.6%,respectively.(2)Analysis of R0:Through the pooled rate,the 1-and 2-year survival rates of R0 resection and non-R0 resection are basically the same,but the 5-year survival rate of R0 resection is much higher than that of non-R0 resection.(3)There was no significant difference in pathologicalⅣandⅤanalysis.(4)The overall recurrence rate was 71.2%,and the recurrence rate was not significantly different.(5)Perioperative complications and mortality are high,complications of pancreatic fistula,abdominal infection,liver failure,etc.,and the causes of perioperative death are not the same.Conclusion HPD has a certain value in the treatment of gallbladder cancer.The above conclusions need to be further verified by RCT controlled studies.