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

余佩和; 苏松; 陈诗; 王锦程; 陈鑫培; 罗德

doi:10.3969/j.issn.1001-5256.2020.08.026

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

DOI: 10.3969/j.issn.1001-5256.2020.08.026

1. 西南医科大学附属医院肝胆外科
2. 西南医科大学附属医院甲状腺外科

基金项目:

四川省科技厅基金资助项目(20ZDYF1229)；

详细信息

中图分类号: R735.9
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出版历程
- 出版日期: 2020-08-20

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

The Affiliated Hospital of Southwest Medical University

Research funding:

摘要

摘要:
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=2.6...
- 胰腺肿瘤 /
- 胰十二指肠切除术 /
- 胰十二指肠切除联合全系膜切除术 /
- 治疗结果 /
- Meta分析(主题)
Abstract:
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.
- pancreatic neoplasms /
- pancreaticoduodenectomy /
- total mesopancreas excision with pancreaticoduodenectomy /
- treatment outcome /
- Meta-analysis as topic

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参考文献(19)

[1] TANG WH,TANG JX,YUAN ZR. Several issues that need to be taken seriously in the surgical treatment of pancreatic head carcinoma[J]. Int J Surg,2019,46(1):13-16.(in Chinese)唐文皓，唐健雄，袁祖荣．胰头癌外科治疗中应注意的几个问题[J]．国际外科学杂志，2019,46(1):13-16.

[2] ZHAO C,DAI CL. Methods and significance for improving the preoperative qualitative diagnosis of periampullary cancer[J].J Hepatobiliary Surg,2018,26(4):245-250.(in Chinese)赵闯，戴朝六．提高壶腹周围癌术前定性诊断的方法及意义[J]．肝胆外科杂志，2018,26(4):245-250.

[3] ADHAM M,SINGHIRUNNUSORN J. Surgical technique and results of total mesopancreas excision(TMpE)in pancreatic tumors[J]. Eur J Surg Oncol,2012,38(4):340-345.

[4] WU WG,WANG XA,WU XS,et al. Total mesopancreas excision for pancreatic head cancer:Analysis of 120 cases[J].Chin J Cancer Res,2016,28(4):423-428.

[5] LUCHINI C,STUBBS B,SOLMI M,et al. Assessing the quality of studies in Meta-analyses:Advantages and limitations of the Newcastle Ottawa Scale[J]. World J of Meta-Analysis,2017,5(4):80.

[6] KAWABATA Y,TANAKA T,NISHI T,et al. Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma[J]. Eur J Surg Oncol,2012,38(7):574-579.

[7] AIMOTO T,MIZUTANI S,KAWANO Y,et al. Left posterior approach pancreaticoduodenectomy with total mesopancreas excision and circumferential lymphadenectomy around the superior mesenteric artery for pancreatic head carcinoma[J]. J Nippon Med Sch,2013,80(6):438-445.

[8] XU JY,TIAN XD,CHEN YR,et al. Total mesopancreas excision for the treatment of pancreatic head cancer[J]. J Cancer,2017,8(17):3575-3584.

[9] XU YK,SU S,GAN Y,et al. Safety and efficacy of total mesopancreas excision with pancreaticoduodenectomy in treatment of periampullary carcinoma and pancreatic head carcinoma[J]. Chin J Bases Clin Gen Surg,2018,25(12):1464-1468.(in Chinese)徐云柯，苏松，淦宇，等．胰腺全系膜切除的胰十二指肠切除术治疗壶腹周围癌及胰头癌的安全性及疗效分析[J]．中国普外基础与临床杂志，2018,25(12):1464-1468.

[10] ZHANG D. The value of total mesopancreas excision in pancreatoduodenectomy[D]. Fuzhou:Fujian Medical University,2017.(in Chinese)张迪．胰腺全系膜切除在胰十二指肠切除术中应用价值[D]．福州:福建医科大学，2017.

[11] LI B,GUO SW,JIANG H,et al. Resection margin of pancreatic cancer:Consensus and controversy[J]. Chin J Pract Surg,2019,39(9):983-987.(in Chinese)李勃，郭世伟，蒋慧，等．胰腺癌手术切缘共识与争议[J]．中国实用外科杂志，2019,39(9):983-987.

[12] DU L,XU XJ,GENG C,et al. Efficacy of pancreaticoduodenectomy combined with portal vein/superior mesenteric vein resection for pancreatic head cancer[J]. Chin J Gen Surg,2016,25(3):381-386.(in Chinese)杜露，徐新建，耿城，等．联合门静脉/肠系膜上静脉切除的胰十二指肠术治疗胰头癌的疗效[J]．中国普通外科杂志，2016,25(3):381-386.

[13] LIU YB,LI YS,WANG XA. Application and progress of total mesopancrease excision in radical resection of pancreatic head cancer[J]. J Abdominal Surg,2019,32(5):315-318,323.(in Chinese)刘颖斌，李永盛，王许安．全系膜切除理念在胰头癌根治术中的应用与研究进展[J]．腹部外科，2019,32(5):315-318,323.

[14] YAO HC. Analysis of risk factors for recurrence after pancreatoduodenectomy[D]. Changchun:Jilin University,2018.(in Chinese)姚浩琛．胰头癌胰十二指肠切除术后复发危险因素分析[D]．长春:吉林大学，2018.

[15] BAGHMAR S,AGRAWAL N,KUMAR G,et al. Prognostic factors and the role of adjuvant treatment in periampullary carcinoma:A single-centre experience of 95 patients[J]. J Gastrointest Cancer,2019,50(3):361-369.

[16] SUN WB. Detailed measures to reduce the incidence and severity of pancreatic fistula after pancreaticoduodenectomy[J]. Chin J Hepatobiliary Surg,2019,25(7):481-486.(in Chinese)孙文兵．降低胰十二指肠切除切除术后胰瘘发生率和严重性的细节性措施[J]．中华肝胆外科杂志，2019,25(7):481-486.

[17] YI B,WU X,YANG J,et al. Risk factor for delayed gastric emptying after pancreaticoduodenectomy[J]. Chin J Gen Surg,2018,33(3):248-249.(in Chinese)易彬，伍星，杨健，等．胰十二指肠切除术后胃排空障碍的危险因素分析[J]．中华普通外科杂志，2018,33(3):248-249.

[18] LI GZ,ZHU ZW,WANG SP,et al. Predictive value of procalcitonin for early abdominal infection after pancreatoduodenectomy[J]. Chin J Pancreatol,2018,18(5):313-317.(in Chinese)李广洲，朱宗文，王水平，等．降钙素原对胰十二指肠切除术后腹腔感染早期的预测价值[J]．中华胰腺病杂志，2018,18(5):313-317.

[19] QIN RY. Reflection on and improvement of digestive tract reconstruction after pancreatoduodenectomy[J]. Chin J Dig Surg,2011,10(5):335-337.(in Chinese)秦仁义．胰十二指肠切除后消化道重建方式的思考与改进[J]．中华消化外科杂志，2011,10(5):335-337.

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