腹腔镜与开腹胰十二指肠切除术:系统回顾及RCT研究的meta分析

目的:评价腹腔镜胰十二指肠切除术的安全性及可行性。方法:全面检索PubMed、Embase、Cochrane数据库、中国期刊全文数据库(CNKI)、万方数据库及ClinicalTrials.gov数据库,检索时间限定为建库至2019年3月16日。纳入文献类型定为随机对照实验(RCTS)。本研究采用术后90 d内死亡率、术后胰瘘发生率、手术时间、失血量、住院时间、R0切除率、淋巴结清扫数量等指标评价LPD的安全性及可行性。结果:本研究纳入3篇RCTS共计224例患者,其中实验组114例,对照组110例。两组手术时间(WMD 97.93,95%CI 19.93,175.94,P=0.01,I2=93%)、术中失血量(WMD-184.04,95%CI-288.89,-79.19,P=0.0006,I2=54%),手术部位感染率(RR 0.40,95%CI 0.16,0.96,P=0.04,I2=0)差异有统计学意义;两组术后90 d内死亡率、术后胰瘘发生率、住院时间、胃排空延迟发生率差异无统计学意义(P>0.05)。结论:考虑到LPD的死亡率、术后胰瘘风险与OPD无明显差异,可认为LPD的安全性与OPD相当。在安全性相当的条件下,LPD需要更长的手术时间,不明显缩短住院时间,且具有高达16.7%的中转开腹率,可认为LPD相较OPD无明显优越性。

Laparoscopic pancreatoduodenectomy vs.open pancreatoduodenectomy:a systematic review and meta-analysis of randomized controlled trials

Objective:To assess and evaluate the safety and feasibility of laparoscopic pancreatoduodenectomy(LPD)compared with open pancreatoduodenectomy(OPD)based on randomized controlled trials(RCTs).Methods:Pubmed,Embase,Cochrane database,CNKI,WanFang Data and ClinicalTrials.gov were searched for RCTs on LPD versus OPD before March 16,2019.Mortality within 90 days,postoperative pancreatic fistula,operative time,estimated blood loss,length of hospital stay,R0 resection rate and retrieved lymph nodes were compared.Results:After screening records,3 RCTs were included in meta-analysis.224 cases were enrolled,114 cases were LPD,110 cases were OPD.No difference was found in mortality within 90 days,postoperative pancreatic fistula,length of hospital stay and delayed gastric emptying(P>0.05).There was significant difference in operative time(WMD 97.93,95%CI 19.93,175.94,P=0.01,I2=93%),estimated blood loss(WMD-184.04,95%CI-288.89,-79.19,P=0.0006,I2=54%)and surgical site infection(RR 0.40,95%CI 0.16,0.96,P=0.04,I2=0).Conclusions:LPD is as safe as OPD with regarding to both surgical and oncological outcome concerning about that LPD does not differ from OPD in mortality within 90 days and postoperative pancreatic fistula.But LPD has longer operative time,not significantly shorter length of hospital stay,and considerable conversion(16.7%),thus,there is still no result showing that LPD has obvious benefit compared with OPD.