动脉优先入路与传统入路胰十二指肠切除术疗效比较的Meta分析

目的比较动脉优先入路与传统入路胰十二指肠切除术的疗效。方法系统检索2003年1月1日至2020年1月31日PubMed、Embase、Cochrane Library、万方、知网、维普数据库中关于动脉优先入路和传统入路胰十二指肠切除术的随机对照研究和非随机对照研究,根据纳入与排除标准筛选文献。应用RevMan5.3统计软件进行Meta分析。对研究中的连续性变量及二分类变量分别采用均数差(MD)及比值比(OR)为效应分析统计量,各统计量分别计算95%可信区间(95%CI)。异质性不明显,采用固定效应模型;异质性明显,则使用随机效应模型。采用漏斗图检验是否存在发表偏倚。结果共纳入18篇文献,Meta分析结果显示:动脉优先入路胰十二指肠切除术与传统入路胰十二指肠切除术相比,可减少胰瘘、术后胃排空障碍、术后腹腔感染、局部复发、输血发生率并提高R0切除率[OR(95%CI)分别为0.68(0.48~0.94)、0.51(0.35~0.73)、0.50(0.30~0.84)、0.36(0.20~0.65)、0.20(0.07~0.59)、3.04(1.86~4.99),P值均<0.05]。胰瘘发生率、术后胃排空障碍发生率漏斗图基本对称,提示本研究结果受纳入文献偏倚影响较小。结论动脉优先入路与传统入路胰十二指肠切除术一样安全可行,动脉优先入路在降低部分重要术后并发症以及提高R0切除率方面优于传统入路,该术式值得推广。

Clinical effect of artery-first approach versus traditional approach for pancreaticoduodenectomy:A Meta-analysis

Objective To investigate the clinical effect of the artery-first approach versus the traditional approach for pancreaticoduodenectomy.Methods PubMed,Embase,Cochrane Library,Wanfang Data,CNKI,and VIP were searched for randomized controlled trials(RCTs)and non-RCTs on the artery-first approach versus the traditional approach for pancreaticoduodenectomy published from January 1,2003 to January 31,2020,and the articles were screened according to inclusion and exclusion criteria.RevMan5.3 software was used to perform the meta-analysis.Mean difference and odds ratio(OR)were used to analyze continuous variables and binary variables,95%confidence interval(CI)was calculated for each variable.The fixed effects model was used for unobserved heterogeneity,and the random effects model was used for significant heterogeneity.Funnel plots were used to evaluate the absence or presence of publication bias.Results A total of 18 articles were included.The results of the meta-analysis showed that compared with pancreaticoduodenectomy with the traditional approach,pancreaticoduodenectomy with the artery-first approach reduced pancreatic fistula(OR=0.68,95%CI:0.48-0.94,P<0.05),delayed gastric emptying after surgery(OR=0.51,95%CI:0.35-0.73,P<0.05),postoperative abdominal infection(OR=0.50,95%CI:0.30-0.84,P<0.05),local recurrence(OR=0.36,95%CI:0.20-0.65,P<0.05),and incidence rate of blood transfusion(OR=0.20,95%CI:0.07-0.59,P<0.05)and increased R0 resection rate(OR=3.04,95%CI:1.86-4.99,P<0.05).Symmetric funnel plots were observed for the incidence rates of pancreatic fistula and delayed gastric emptying after surgery,suggesting that publication bias of the articles included had little influence on the results of this study.Conclusion The artery-first approach is as safe and feasible as the traditional approach for pancreaticoduodenectomy,and the artery-first approach is superior to the traditional approach in reducing some important postoperative complications and increasing R0 resection rate.Therefore,the artery-first approach holds promise for clinical application.