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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2021, Vol. 14 ›› Issue (01): 37 -43. doi: 10.3877/cma.j.issn.1674-6899.2021.01.009

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腹腔镜对比开腹远端胰腺切除术治疗胰腺导管腺癌的Meta分析
贾勇 1, 刘红阳 1, 张宾儒 1, 李林峰 1, 王浩年 1, 陈华 1 , †( ), 孙备 1   
  1. 1. 150001 哈尔滨医科大学附属第一医院胰胆外科
  • 收稿日期:2020-12-16 出版日期:2021-02-28
  • 通信作者: 陈华

Laparoscopic versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a Meta-analysis

Yong Jia 1, Hongyang Liu 1, Binru Zhang 1, Linfeng Li 1, Haonian Wang 1, Hua Chen 1 , †( ), Bei Sun 1   

  1. 1. Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
  • Received:2020-12-16 Published:2021-02-28
  • Corresponding author: Hua Chen
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目的

对比腹腔镜及开腹远端胰腺切除术治疗胰腺导管腺癌(pancreatic ductal adenocarcinoma ，PDAC)的疗效及安全性。

方法

检索2020年10月前公开发表的比较腹腔镜远端胰腺切除术(laparoscopic distal pancreatectomy，LDP)与开腹远端胰腺切除术(open distal pancreatectomy，ODP)治疗PDAC的临床研究。经过筛选，对纳入文献进行质量评价及数据提取，然后使用review manager(RevMan)5.3软件进行统计分析。

结果

共计15项研究，5 343例患者纳入本研究(LDP组1 396例，ODP组3 947例)。LDP组的术中出血量低[加权均数差(weighted mean difference, WMD)＝-112.44，95%置信区间(confidence interval, CI)：-193.06～-31.82，P＝0.006]、输血率低(OR＝0.33，95%CI：0.23～0.49，P<0.000 01)、住院时间短(WMD＝-3.35，95%CI：-4.57～-2.13，P<0.000 01)、R0切除率高(OR＝1.30，95%CI：1.04～1.64，P＝0.02)、3年生存率高(HR＝0.84，95%CI：0.76～0.92，P＝0.000 4)以及5年生存率高(HR＝0.82，95%CI：0.74～0.92，P＝0.000 8)。

结论

治疗胰体尾部PDAC时，LDP相较于ODP在术中出血量、输血率以及住院时间方面更具有优势，同时也有着不弱于ODP的肿瘤学结局。鉴于本研究的局限性，此结果仍需要大样本前瞻性随机对照研究证实。

关键词: 腹腔镜, 远端胰腺切除术, 胰腺癌, Meta分析
Objective

Comparison of the safety and efficacy of laparoscopic and open distal pancreatectomy in the treatment of pancreatic ductal adenocarcinoma.

Methods

The published clinical studies including laparoscopic distal pancreatectomy(LDP) and open distal pancreatectomy(ODP) in treatment of pancreatic ductal adneocarcinoma(PDAC) before Oct. 2020 were reviewed. After screening, the included literature was subjected to quality evaluation and data extraction, and then, statistical analysis was performed using review manager(RevMan) 5.3 software.

Results

Fifteen studies with a total of 5 343 patients(1 396 in LDP and 3 947 in ODP) were included for the meta-analysis.LDP showed less blood loss(weighted mean difference, WMD)=-112.44, 95%CI(confidence interval, CI): -193.06-31.82, P=0.006), lower blood transfusion rate(OR=0.33, 95%CI: 0.23-0.49, P<0.000 01), shorter hospitalization time(WMD=-3.35, 95%CI: -4.57--2.13, P<0.000 01), higher R0 resection rate(OR=1.30, 95%CI: 1.04-1.64, P=0.02), higher 3-year overall survival(HR=0.84, 95%CI: 0.76-0.92, P=0.000 4) and 5-year overall survival(HR=0.82, 95%CI: 0.74-0.92, P=0.000 8).

Conclusions

LDP has advantages over ODP in terms of intraoperative bleeding, transfusion rates, and length of stay in the treatment of PDAC in the body and tail of the pancreas, and also has oncologic outcomes that are not inferior to those of ODP.Given the limitations of this study, this result still needs to be confirmed in a large prospective randomized controlled study.

Key words: Laparoscopy, Distal pancreatectomy, Pancreatic ductal adenocarcinoma, Meta-analysis
图1 文献筛选流程
表1 纳入文献的NOS评价表
作者 年份 评分(分) 总评分(分)
① ② ③ ④ ⑤ ⑥ ⑦ ⑧
Kooby等[ 14 ] 2010 1 1 1 1 1 1 1 1 8
Hu等[ 15 ] 2014 1 1 1 1 1 1 1 1 8
Rehamn等[ 16 ] 2014 1 1 1 1 1 1 1 1 8
Braga等[ 17 ] 2015 1 1 1 1 1 1 0 0 6
Lee等[ 18 ] 2015 1 1 1 1 1 1 0 0 6
Shin等[ 19 ] 2015 1 1 1 1 1 1 1 1 8
Sulipice等[ 20 ] 2015 1 1 1 1 1 1 1 1 8
Zhang等[ 21 ] 2015 1 1 1 1 2 1 1 1 9
Stauffer等[ 22 ] 2016 1 1 1 1 1 1 1 1 8
Joliat等[ 23 ] 2017 1 1 1 1 1 1 0 0 6
Wellner等[ 24 ] 2017 1 1 1 1 2 1 0 0 7
Zhang等[ 25 ] 2017 1 1 1 1 2 1 1 1 9
Jarufe等[ 26 ] 2018 1 1 1 1 1 1 1 1 8
Chen等[ 27 ] 2020 1 1 1 1 2 1 1 1 9
Watson等[ 28 ] 2020 1 1 1 1 2 1 1 1 9
表2 部分统计结果
结局指标 纳入研究数量 异质性 总体结果 95%CI P值
P值 I2值
年龄 8 0.007 64% WMD＝-1.68 -3.96～0.61 0.15
体质量指数 7 0.009 65% WMD＝0.66 -0.05～1.36 0.07
手术时间 8 <0.000 1 79% WMD＝5.21 -16.97～27.38 0.65
术后胰瘘 5 0.970 0% OR＝1.69 0.99～2.91 0.06
临床相关胰瘘 6 0.550 0% OR＝1.12 0.62～2.01 0.70
Clavien-DindoⅢ级以上并发症发生率 4 0.330 12% OR＝0.60 0.29～1.22 0.16
术后辅助治疗时间 3 0.004 82% WMD＝-4.33 -9.46～0.81 0.10
术后辅助化疗患者例数 5 0.720 0% OR＝1.11 0.91～1.34 0.30
图2 森林图
图3 漏斗图
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