腹腔镜胰十二指肠切除术的临床研究:meta分析

【摘要】〓目的〓分析腹腔镜十二指肠切除术的安全性和可行性。方法〓通过关键词“腹腔镜、胰十二指肠切除术”检索知网、维普和万方等数据库以及“Laparoscopic pancreaticoduodenectomy”检索了CBM、PubMed、MEDLINE、Embase、Cochrane Library等数据库,共得到874篇相关文献,纳入本文研究的为8篇,比较分析腹腔镜胰十二指肠切除术和开放式胰十二指肠切除术的围手术期的9个参数(手术时间、术中出血量、住院时间、再次手术率、胰瘘发生率、伤口感染发生率、术后出血发生率、并发症发生率、死亡率)。结果〓腹腔镜组手术时间长于开腹组[WMD=-69.96,95%CI (-83.34,56.57),P<0.05];腹腔镜组术中出血量少于开腹组[WMD=363.15,95%CI(87.76, 638.54),P<0.05];腹腔镜组患者住院时间短于开腹组[WMD=3.18,95%CI (2.31,4.05),P<0.05];腹腔镜组再次手术率、胰瘘发生率、伤口感染率、术后出血发生率、总并发症率、死亡率与于开腹组无明显差异。结论〓腹腔镜胰十二指肠切除术与开腹胰十二指肠切除术相比有一定的优势。     

腹腔镜与开腹胰十二指肠切除术临床疗效比较

目的 比较腹腔镜与开腹胰十二指肠切除术的临床疗效。方法 回顾性分析南充市中心医院2014 年6 月至2019 年8 月期间完成的104 例胰十二指肠切除术患者资料，其中包含胰头癌47 例，十二指肠乳头癌31 例，胆管下段癌26 例，根据已行的手术方式分为腹腔镜胰十二指肠切除组（A组，n=40）和开腹胰十二指肠切除组（B组，n=64）。比较两组的手术时间、术中出血量、平均排气时间、术后下床活动时间、住院时间及术后并发症发生情况。结果 两组手术时间和术中出血量无统计学差异（P＞0．05），平均排气时间、术后下床活动时间及住院时间A组小于B组（P＜0．05）。其中A组术后发生胰瘘5 例，胆漏4 例，腹腔内出血1 例，胃瘫综合征3 例；B组术后发生胰瘘9 例，胆漏5 例，腹腔内出血1 例，胃瘫综合征4 例，余无明显严重并发症发生；两组术后总并发症发生率无明显差异（P＞0．05）。结论 腹腔镜和开腹胰十二指肠切除术均安全有效，但腹腔镜胰十二指肠切除术后恢复优于开腹胰十二指肠切除术。     

基于倾向性得分匹配腹腔镜与开腹胰十二指肠切除术安全性和疗效分析

目的:评估腹腔镜胰十二指肠切除术(LPD)的安全性和疗效。方法:回顾性分析湖南省人民医院2015年1月至2019年12月989例行胰十二指肠切除术患者临床资料,其中LPD组349例,开腹胰十二指肠切除术(OPD)组640例。使用倾向性得分匹配对两组患者基线资料进行1∶1匹配,比较匹配后两组患者的手术时间、术中出血量、术...     

腹腔镜与开腹胰十二指肠切除术治疗远端胆管癌疗效分析

目的:评估腹腔镜与开腹胰十二指肠切除术治疗远端胆管癌的近期疗效、根治性效果和远期生存情况 。方法:回顾性分析湖南省人民医院2015年1月至2019年12月行胰十二指肠切除术治疗的200例远端胆管癌患者的临床资料,其中行腹腔镜胰十二指肠切除术（LPD组）101例,开腹胰十二指肠切除术（OPD组）99例。比较两...     

机器人与开腹胰十二指肠切除术疗效的Meta分析

目的：通过Meta分析比较机器人胰十二指肠切除术(RPD)与开腹胰十二指肠切除术（OPD）的疗效。方法：通过检索Pubmed、Embase、Web of Science、Cochrane Library、中国知网、万方数据库及维普数据库,英文检索词包括：pancreaticoduodenectomy、duodenopanreatectpmy、whipple、robotic、Da Vinci。中文检索词包括：胰十二指肠切除、机器人、达芬奇。比较RPD组与OPD组患者术后死亡率、手术时间、术中失血量、术后胰瘘发生率、胃排空延迟发生率、术区感染发生率、术后出血发生率及住院时间等指标。采用Rev Man 5.3统计学软件进行Meta分析。结果：本研究最终纳入22项文献共21 653例患者,其中RPD组2 401例,OPD组19 252例。Meta分析结果显示,RPD组与OPD组患者术后死亡率[优势比（OR）=0.80,95%CI:0.48～1.32,P=0.39]、术后胰瘘发生率（OR=0.85,95%CI:0.63～1.15,P=0.29）、胃排空延迟发生率（OR=1.12,95%CI:0....     

腹腔镜胰十二指肠切除术后出血的相关分析与总结

目的:对腹腔镜胰十二指肠切除术(LPD)术后出血情况进行分析和经验总结。方法:回顾性分析2011年5月至2019年12月期间在湖南省人民医院行LPD的患者的临床资料。对其一般资料、术后出血的时间、出血部位、胆瘘、胰瘘和感染等短期并发症及再次手术等进行分析及经验总结。结果:共356例患者纳入研究,其中男性200例,女性1...     

全腹腔镜胰十二指肠切除术与传统开放手术治疗胰腺恶性肿瘤的近期疗效分析

目的:探讨完全腹腔镜与开放胰十二指肠切除术治疗胰腺恶性肿瘤的近期疗效。方法:回顾分析2016年9月至2021年9月施行的79例完全腹腔镜胰十二指肠切除术(TLPD)与97例开放胰十二指肠切除术(OPD)患者的临床资料,其中TLPD组中女41例,男38例,平均(60.8±20.2)岁;OPD组中女38例,男59例,平均(59.4±19.0)岁。对比分析两组术前、术中与术后近期相关指标。结果:TLPD组手术时间[(172.3±47.5)min vs.(196.0±62.1)min,P=0.004]、术中出血量[(192.1±25.2)mL vs.(380.7±76.9)mL,P<0.0001]、下床活动时间[(2.0±0.7)d vs.(3.1±1.1)d,P<0.0001]、排气时间[(4.0±0.5)d vs.(5.7±0.2)d,P<0.0001]、进食时间[(4.8±0.8)d vs.(5.7±1.5)d,P<0.0001]、引流管拔除时间[(9.4±0.9)d vs.(10.3±2.8)d,P=0.001]优于OPD组,差异有统计学意义;两组术后胰瘘、胆漏...     

腹腔镜胰十二指肠切除术的疗效分析

目的评估腹腔镜胰十二指肠切除术的疗效,探讨腹腔镜胰十二指肠切除术的安全性和可行性。方法回顾性分析2014年1月~2016年12月我院43例胰十二指肠切除术患者的临床资料,其中腹腔镜22例,开腹21例。对比二组患者手术时间、术中出血量、术后肛门排气时间、术后住院时间、术后并发症和清扫淋巴结数目。结果与开腹组比较,腹腔镜组总的手术时间长(414.0±31.0 min vs.263.8±34.4 min,t=11.634,P0.001),但术中出血量少(176.0±50.4 m L vs.290.8±41.9 m L,t=-6.613,P=0.01),术后肛门排气早(4.9±0.7 d vs.6.7±0.8 d,t=-5.724,P=0.025),术后住院时间短(17.3±2.0 d vs.21.3±3.2 d,t=-3.514,P=0.002),二组术后并发症、清扫淋巴结数目的差异无统计学意义。结论与开腹手术相比,腹腔镜胰十二指肠切除术同样遵循肿瘤根治原则,而且安全可行。     

腹腔镜胰十二指肠切除术12例报告

目的：探讨腹腔镜胰十二指肠切除术的价值。方法：回顾分析2005年5月至2008年7月为12例患者施行腹腔镜胰十二指肠切除术的临床资料。结果：5例完全腹腔镜下操作,4例行手助腹腔镜手术,3例中转开腹。手术时间5~10h,平均6.5h。术中出血200~800ml,平均435ml。术后第1天腹腔引流量30~120ml,平均65ml,术后1~4d排气,平均2d。1例术后第6天出现胆漏,引流量最多40ml/d,术后14d拔除引流管。住院11~21d,平均15d。术后随访3~36个月,2例胰头癌患者分别存活16个月和22个月,1例胆总管下段癌患者术后15个月发现肝脏和腹膜后淋巴结转移,其余9例无并发症发生。结论：腹腔镜胰十二指肠切除术具有一定的微创优势,安全可行。     

Laparoscopic vs open pyloromyotomy: a systematic review and meta-analysis

Purpose

The aim of the study was to determine whether laparoscopic pyloromyotomy (LP) or open pyloromyotomy (OP) is the most effective intervention in infants with hypertrophic pyloric stenosis.

Methods

A systematic review of the published literature was undertaken in February 2009. Prospective studies comparing LP and OP were selected. Age, weight, complications, duration of operation, time to full feedings, postoperative vomiting, and postoperative length of stay (LOS) data were extracted.

Results

Six prospective studies (5 level I, 1 level II) with 625 (303 LP, 322 OP) participants met selection criteria. Combined estimates indicated that LP had a lower total complication rate (odds ratio [OR], 0.58 [0.35, 0.97]; P = .04), mostly due to a lower wound complication rate (OR, 0.42 for LP [0.20, 0.91]; P = .03). Patients who underwent LP also had shorter time to full feedings (mean difference [MD], −11.52 hours [−12.77, −10.27]; P < .00001) and shorter postoperative LOS (MD, −5.71 hours [−8.90, −2.52]; P = .0005). No statistically significant differences were noted in the rates of mucosal perforation, wound infection, postoperative emesis, or operating time. Incomplete pyloromyotomy occurred in 6 patients who underwent LP (OR, 7.74 [0.94, 63.38]; P = .06).

Conclusions

This meta-analysis favors the laparoscopic approach with significantly reduced rate of total complications, which is mostly due to a lower wound complication rate.     

Laparoscopic vs conventional appendectomy – a meta-analysis of randomised controlled trials

Aim: To compare the effectiveness and safety of laparoscopic and conventional “open” appendectomy in the treatment of acute appendicitis. Methods: Meta-analysis of randomised controlled trials available by May 1998 that compared both techniques. Within each trial and for each outcome an effect size was calculated; the effect sizes were then pooled by a random-effects model. Results: We summarised outcome data of 2877 patients included in 28 trials. Operating time was +16 min (95% confidence interval +12–20 min) longer for laparoscopic appendectomy. Overall complication rates were comparable, but wound infections were definitely reduced after laparoscopy [rate difference –4.2%, (–2.3% to –6.1%)]. Intra-abdominal abscesses, however, occurred slightly more frequently [+0.9%, (–0.4% to +2.3%)]. Hospital stay after laparoscopic appendectomy was 15 h (8–23 h) shorter, and patients returned to full fitness or work 7 days (5–9 days) earlier. Pain intensity on day 1 was slightly less. Heterogeneity was present for some outcome measures due to methodological differences among the primary studies. Conclusion: Laparoscopic appendectomy reduces wound infections and eases postoperative recovery. Nevertheless, the various differences among the primary studies and their partly flawed methodology make it difficult to generalise from these findings. Received: 25 May 1998     

Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systemic review and meta-analysis

Purpose

Laparoscopic herniorrhaphy (LH) has been evolved as a minimally invasive technique for pediatric inguinal hernias (PIHs). Considerable debate exists regarding the benefits of LH over conventional open herniorrhaphy (OH). The aim of this review was to critique the current literature to determine the efficacy of LH.

Methods

Published studies until July 30, 2010, were searched from Medline, Embase, Ovid, Web of Science, and Cochrane databases. Randomized controlled trials (RCTs) and observational clinical studies (OCSs) with a comparison of LH and OH were included. A systemic review and meta-analysis were performed using the odds ratios (ORs) for dichotomous variables and weighted mean differences (WMDs) for continuous variables.

Results

Of 138 studies, 3 RCTs and 4 OCSs were eligible for inclusion criteria, comprising 1543 cases of LH and 657 cases of OH. Compared with OH, shorter operative time for bilateral hernias (WMD = −11.14; 95% confidence interval [CI], −20.61 to −1.68; P = .02) and lower rate of metachronic contralateral hernia (OR, 0.26; 95% CI, 0.09-0.76; P = .01) were noted in LH. However, no significant difference was observed between LH and OH in patients' age, sex, affected side, operative time for unilateral hernias, duration of hospital stay, time to resume full activity, recurrence, and complications.

Conclusions

Laparoscopic herniorrhaphy is superior to OH in the repair of bilateral PIH and lower rate of metachronic contralateral hernia, with similar operative time for unilateral hernias, length of hospital stay, recurrence, and complication rates. Because of the publishing bias, a series of RCTs with standard report format and uniform unit are necessary to explore the efficiencies of LH in the management of PIH.     

治疗成人腹股沟疝选择腹腔镜或开放Lichtenstein修补术——随机对照研究的Meta分析

目的:比较腹腔镜经腹腔腹膜前修补(transabdominal preperitoneal prosthetic TAPP)或腹腔镜完全腹膜外修补(to-tal extraperitoneal prosthetic,TEP)和开放Lichtenstein修补术治疗腹股沟疝的疗效与成本。方法:检索1990年1月至2004年12月31日PUDMED、EMBSE、MEDALINE、中国学术期刊网全文数据库收录的公开发表与研究目的相关的手术临床随机对照(RCTs)的研究文献,提取数据,满足条件者对数据进行合并分析,Meta分析软件用Revman4.2。评价指标包括:手术时间、围手术期总并发症、复发率和治疗费用。结果:有12个RCTs,1 763例患者纳入分析,腹腔镜组870例,其中TAPP 605例,TEP265例;开放Lichtenstein修补893例,Meta分析显示,腹腔镜手术比开放Lichtenstein手术的手术时间长。围手术期总并发症发生率相当。随访2-36个月,复发率相当。4项研究表明,腹腔镜组的手术费用较高。结论:目前证据提示,综合成本与疗效评价,原发的单侧腹股沟疝患者推荐采用Lichtenstein术式,复发双侧的腹股沟疝或有特殊要求的患者,腹腔镜手术可能是较好的选择。     

Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials

Background

The best reconstruction method for the pancreatic remnant after pancreaticoduodenectomy remains debatable. We aimed to investigate the perioperative outcomes of 2 popular reconstruction methods: pancreaticogastrostomy and pancreaticojejunostomy.

Data Sources

Randomized controlled trials comparing pancreaticogastrostomy versus pancreaticojejunostomy were identified from literature databases (MEDLINE/PubMed, EMBASE, Web of Science, Cochrane Library).The meta-analysis included 8 studies: 607 patients who underwent pancreaticogastrostomy and 604 who underwent pancreaticojejunostomy. Postoperative pancreatic fistula and intra-abdominal fluid collection rates were significantly lower after pancreaticogastrostomy compared with pancreaticojejunostomy. No statistically significant differences were found in the incidence of delayed gastric emptying, biliary fistula, hemorrhage, reoperation, wound infection, overall morbidity, mortality, and length of hospital stay.

Conclusions

Our meta-analysis suggests that pancreaticogastrostomy not only reduces the rate of postoperative pancreatic fistula but also decreases its severity. Pancreaticogastrostomy is associated with a lower rate of intra-abdominal fluid collection. Our results suggest that pancreaticogastrostomy should be the preferred reconstruction method.     

腹腔镜阑尾切除与开腹阑尾切除术的对比研究及Meta分析

目的比较腹腔镜与开腹阑尾切除术对急性阑尾炎的疗效和手术安全性。方法收集2006年10月至2007年10月问120例急性阑尾炎患者进行前瞻性研究,随机分为两组,分别采用腹腔镜阑尾切除（LA）术式和开腹阑尾切除（OA）术式,对手术时间、术中出血量、术后胃肠功能恢复时间、止痛药物应用时间、开始进食时间、住院天数和术后并发症等指标进行比较分析。并对1996年1月至2008年12月期间的该类前瞻性随机对照研究（RCT）文献进行Meta分析,比较两种术式手术时间、住院天数和并发症等指标。结果本组资料表明,两组手术时间、出血量无明显差异,而LA组肠功能恢复时间、止痛药物应用时间、住院天数明显短于OA组,LA组手术并发症也少于OA组;Meta分析有6组资料纳入,LA住院天数和手术并发症少于OA组,而两组的手术时间无明显差异。结论腹腔镜阑尾切除术具有恢复时间短、术后疼痛轻、住院时间短和并发症发生率低等优点,值得推荐。     

老年人腹股沟疝腹腔镜与开腹手术的疗效及安全性评价:Meta分析

目的分析腹腔镜与开腹手术对于治疗老年人腹股沟疝的疗效与安全性。方法检索万方、中国知网、PubMed、EMBASE、Cochrane Library等电子数据库,并人工检索相关电子期刊,针对筛选出的临床随机对照试验,运用Meta分析的方法综合比较相关指标并做综合评价。结果最终纳入8篇文献,共计818例老年病人。腹腔镜组与开腹组相比,在手术时间上差异无统计学意义(SMD=0.00,95%CI:-1.41~1.41,P=0.99);但住院时间更短(SMD=-1.64,95%CI:-2.06~-1.22,P0.01);并发症数量也较少(RR=0.31,95%CI:0.19~0.50,P0.01);治疗有效率更高(OR=3.17,95%CI:1.06~9.49,P=0.04)。结论腹腔镜治疗老年人腹股沟疝具有明显优势,应成为主要术式。     

Prophylactic intra-abdominal drainage following colorectal anastomoses. A systematic review and meta-analysis of randomized controlled trials

BackgroundClinically evident Anastomotic Leakage (AL) remains one of the most feared complications after colorectal resections with primary anastomosis. The primary aim of this systematic review and meta-analysis was to determine whether Prophylactic Drainage (PD) after colorectal anastomoses confers any advantage in the prevention and management of AL.MethodsSystematic literature search was performed using MEDLINE, the Cochrane Central Register of Controlled Trials, and EMBASE databases for randomized studies comparing clinical outcomes of patients with Drained (D) or Undrained (UD) colorectal anastomoses performed for any cause.ResultsFour randomized controlled trials comparing D and UD patients undergoing colorectal resections with primary anastomosis were included for quantitative synthesis. In total, 1120 patients were allocated to group D (n = 566) or group UD (n = 554). The clinical AL rate was 8.5% in the D group and 7.6% in the UD group, with no statistically significant difference (P = 0.57). Rates of radiological AL (D: 4.2% versus UD: 5.6%; P = 0.42), mortality (D: 3.6% versus UD: 4.4%; P = 0.63), overall morbidity (D: 16.6% versus UD: 18.6%, P = 0.38), wound infection (D: 5.4% versus UD: 5.3%, P = 0.95), pelvic sepsis (D: 9.7% versus UD: 10.5%, P = 0.75), postoperative bowel obstruction (D: 9.9% versus UD: 6.9%, P = 0.07), and reintervention for abdominal complication (D: 9.1% versus UD: 7.9%, P = 0.48) were equivalent between the two groups.ConclusionsThe present meta-analysis of randomized controlled trials investigating the value of PD following colorectal anastomoses does not support the routine use of prophylactic drains.