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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 313 -320. doi: 10.3877/cma.j.issn.1674-0793.2021.04.017

循证医学

微创胰十二指肠切除术治疗胰腺导管腺癌围手术期和近远期疗效的Meta分析
丁相元1, 任效瑛1, 闫慧明1,†()   
  1. 1. 030000　太原，山西医科大学第二医院普外科
  • 收稿日期:2020-09-27 出版日期:2021-08-03
  • 通信作者: 闫慧明

Perioperative, short-term and long-term outcomes of minimally invasive pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: A Meta-analysis

Xiangyuan Ding1, Xiaoying Ren1, Huiming Yan1,†()   

  1. 1. Department of General Surgery, the Second Hospital of Shanxi Medical University, Taiyuan 030000, China
  • Received:2020-09-27 Published:2021-08-03
  • Corresponding author: Huiming Yan
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丁相元, 任效瑛, 闫慧明. 微创胰十二指肠切除术治疗胰腺导管腺癌围手术期和近远期疗效的Meta分析[J/OL]. 中华普通外科学文献(电子版), 2021, 15(04): 313-320.

Xiangyuan Ding, Xiaoying Ren, Huiming Yan. Perioperative, short-term and long-term outcomes of minimally invasive pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: A Meta-analysis[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(04): 313-320.

目的

通过Meta分析系统评价微创胰十二指肠切除术（MIPD，腹腔镜胰十二指肠切除术和机器人胰十二指肠切除术）治疗胰腺导管腺癌的围手术期、近期及远期疗效。

方法

检索Web of Science、Pubmed、Embase、中国知网、维普、万方以及中国生物医学文献数据库，截取时间为建库至2020年9月5日，收集关于MIPD和开放胰十二指肠切除术（OPD）治疗胰腺导管腺癌的相关研究，提取数据并进行Meta分析。

结果

最终纳入11项研究11 909例患者，均为回顾性研究，其中1 555例接受了MIPD，10 354例接受了OPD。MIPD组与OPD组在术中输血百分比（OR=0.47，95% CI：0.33~0.68），住院时间（MD= -3.24，95% CI：-5.28~ -1.21），术后总体并发症（OR=0.66，95% CI：0.51~0.86），R0清除率（OR=1.22，95% CI：1.06~1.39），淋巴结切除数（MD=1.19，95% CI：0.05~2.32，P=0.04），3年总体生存率（OR=1.42，95% CI：1.10~1.84），5年总体生存率（OR=2.11，95% CI：1.35~3.31）比较，差异均有统计学意义（P<0.05）。

结论

MIPD治疗胰腺导管腺癌安全性可行。与OPD相比较，MIPD在围手术期相关观察指标、近期及远期肿瘤预后疗效具有更好的效果。

关键词: 微创手术, 胰腺导管腺癌, 胰十二指肠切除术, Meta分析
Objective

To evaluate the perioperative, short-term and long-term outcomes of minimally invasive pancreatoduodenectomy (MIPD, laparoscopic pancreatoduodenectomy and robotic pancreatoduodenectomy) for pancreatic ductal adenocarcinoma by meta-analysis.

Methods

Web of science, PubMed, EMBASE, CNKI, VIP, Wanfang data and Chinese biomedical literature databases were searched from the establishment of the database to September 5, 2020. The related research on MIPD and open pancreaticoduodenectomy (OPD) in the treatment of pancreatic ductal adenocarcinoma was collected, and the data were extracted and analyzed by Meta-analysis.

Results

11 909 patients were included in 11 studies, 1 555 patients received MIPD and 10 354 patients received OPD. There were significant differences in the percentage of intraoperative blood transfusion (OR=0.47, 95% CI: 0.33-0.68), length of hospital stay (MD= -3.24, 95% CI: -5.28-1.21), overall postoperative complications (OR=0.66, 95% CI: 0.51-0.86), R0 clearance rate (OR=1.22, 95% CI: 1.06-1.39), the number of lymph nodes removed (MD=1.19, 95% CI: 0.05-2.32, P=0.04), 3-year overall survival rate (OR=1.42, 95% CI: 1.10-1.84), and 5-year overall survival rate (OR=2.11, 95% CI: 1.35-3.31) (P<0.05).

Conclusions

MIPD is safe and feasible in the treatment of pancreatic ductal adenocarcinoma. Compared with OPD, MIPD shows better effect in perioperative related observation indicators, short-term and long-term tumor prognosis.

Key words: Minimally invasive surgery, Pancreatic ductal adenocarcinoma, Pancreaticoduodenectomy, Meta analysis
表1 纳入研究基线资料的比较
基础信息 文献篇数 异质性 效应模型 Meta分析
I2(%) P值 OR/MD (95% CI) P值
年龄 6 55 0.06 随机效应模型 0.57 (-0.28,1.43) 0.19
性别 5 0 0.42 固定效应模型 1.22 (0.97,1.54) 0.10
体质指数 4 0 0.99 固定效应模型 0.12 (-0.37,0.61) 0.64
肿瘤大小 7 97 <0.001 随机效应模型 -0.12 (-0.55,0.31) 0.58
表2 纳入研究的基本特征及质量评价
第一作者及发表年 国家 研究类型 样本量(例) 中转开腹率[例(%)] 随访时间(月) NOS评分
MIPD OPD MIPD OPD
Chapman 2018[7] 美国 回顾性研究 248 1520 74(29.8) 17.1 14 8
Chen 2015[8] 中国 回顾性研究 19 38 1(5.3) 22±10 21±8 7
Croome 2014[9] 美国 回顾性研究 108 214 7(6.5) 16.5 15.1 8
Delitto 2016[10] 美国 回顾性研究 28 22 - - - 7
Dokmak 2015[11] 法国 回顾性研究 11 261 - - - 6
Kantor 2017[12] 美国 回顾性研究 828 7385 - 18 - 8
Kuesters 2018[13] 德国 回顾性研究 62 278 - - - 7
Kwon 2020[14] 韩国 回顾性研究 73 219 - - - 7
Song 2015[15] 韩国 回顾性研究 15 14 - - - 6
Staufer 2017[16] 美国 回顾性研究 58 193 14(24.1) 19.6±17.4 24.5±27.4 8
Weng 2020[17] 中国 回顾性研究 105 210 2(1.8) - - 7
图1 文献筛选过程图
表3 MIPD组与OPD组围手术期相关结局的比较
指标 文献篇数 样本量(例) 异质性 效应模型 Meta分析
MIPD OPD I2(%) P值 OR/MD(95% CI) P值
手术时间 4 33 895 98 <0.001 随机效应模型 40.17 (-17.75, 99.28) 0.170
术中失血量 4 317 663 91 <0.001 随机效应模型 -110.79 (-266.20, 44.61) 0.160
住院时间 7 1 424 9 814 80 <0.001 随机效应模型 -3.24 (-5.28, -1.21) 0.002
术后总体并发症 5 316 918 23 0.26 固定效应模型 0.66 (0.51, 0.86) 0.002
30 d死亡率 7 1 377 9 882 0 0.65 固定效应模型 1.00 (0.71,1.42) 0.980
术中输血 3 228 685 0 0.80 固定效应模型 0.47 (0.33, 0.68) <0.001
术后胰瘘 5 359 850 0 0.99 固定效应模型 0.87 (0.54, 1.39) 0.550
延迟胃排空 5 359 850 65 0.02 随机效应模型 1.36 (0.51, 3.66) 0.540
术后出血 5 359 850 0 0.57 固定效应模型 1.27 (0.69, 2.35) 0.440
图2 两组患者R0清除率比较的森林图
图3 两组患者静脉切除率比较的森林图
图4 两组患者淋巴结切除数比较的森林图
图5 两组患者术后开始化疗时段比较的森林图
图6 两组患者1年总体生存率比较的森林图
图7 两组患者3年总体生存率比较的森林图
图8 两组患者5年总体生存率比较的森林图
图9 术后总体并发症漏斗图
图10 R0清除率漏斗图
图11 3年总体生存率漏斗图
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