CAJ | 학술논문

目的用Meta分析方法,系统评价腹腔镜胰体尾切除(LDP)与开腹胰体尾切除术(ODP)的疗效.方法计算机检索Cochrane图书馆、MEDLINE、EMBase等数据库,查找2006年1月至2012年12月发表的有关对比分析LDP与ODP疗效的随机对照试验文献.按照纳入与排除标准选择文献、提取资料、评价质量后,采用RevMan 5.0软件进行Meta分析.结果共有14篇研究纳入分析,包括1417例患者,其中LDP组520例,ODP组897例.分析显示:手术时间、保脾率LDP组大于ODP组,差异有统计学意义[(均数差-273.10,95％ CI-354.39～-191.81,P＜0.01)、(OR 2.42,95％ CI 1.78～3.30,P＜0.01)]；术中失血量、禁食时间、住院时间LDP组小于ODP组,差异有统计学意义[(均数差-273.10,95％ CI-354.39～-191.81,P＜0.01)；(均数差-1.78,95％ CI-2.36～-1.20,P＜0.01)；(均数差-3.15,95％ CI-3.97～-2.33,P＜0.01)];输血率、胰瘘发生率、死亡率两组差异无统计学意义.结论 LDP安全可行.与常规开腹手术相比虽然LDP手术时间较长,但在保留脾脏、减少失血量、缩短禁食时间及住院时间方面具有优势.
목적 용Meta분석방법,계통평개복강경이체미절제(LDP)여개복이체미절제술(ODP)적료효.방법 계산궤검색Cochrane도서관、MEDLINE、EMBase등수거고,사조2006년1월지2012년12월발표적유관대비분석LDP여ODP료효적수궤대조시험문헌.안조납입여배제표준선택문헌、제취자료、평개질량후,채용RevMan 5.0연건진행Meta분석.결과 공유14편연구납입분석,포괄1417례환자,기중LDP조520례,ODP조897례.분석현시:수술시간、보비솔LDP조대우ODP조,차이유통계학의의[(균수차-273.10,95％ CI-354.39～-191.81,P＜0.01)、(OR 2.42,95％ CI 1.78～3.30,P＜0.01)]；술중실혈량、금식시간、주원시간LDP조소우ODP조,차이유통계학의의[(균수차-273.10,95％ CI-354.39～-191.81,P＜0.01)；(균수차-1.78,95％ CI-2.36～-1.20,P＜0.01)；(균수차-3.15,95％ CI-3.97～-2.33,P＜0.01)];수혈솔、이루발생솔、사망솔량조차이무통계학의의.결론 LDP안전가행.여상규개복수술상비수연LDP수술시간교장,단재보류비장、감소실혈량、축단금식시간급주원시간방면구유우세.
Objective To evaluate the clinical effectiveness of laparoscopic (LDP) versus open distal pancreatectomy (ODP) using meta-analysis.Methods Comprehensive literature search was conducted on articles only in English published from 2006 to 2012 on MEDLINE,EMbase,Cochrane Central Registry of Controlled Trials to compare LDP with ODP for Pancreatic disease.Data were extracted and evaluated by two reviewers independently.The quality of the included trials was evaluated.Meta-analyses were conducted using the Cochrane Collaboration's RevMan 5.1 software.Results Fourteen controlled clinical trials (n=1417) were included.The LDP group was significantly longer than the ODP group in operation time,and was significantly larger in the number of patients with spleen preservation [(MD-273.10,95％ CI-354.39-191.081,P＜0.01),(OR 2.42,95％ CI 1.78-3.30,P＜0.01) respectively].The LDP group was significantly less than the ODP group in intraoperative blood loss,time to oral intake,and length of hospital stay [(MD-273.10,95％ CI -354.39-191.81,P＜0.01),(MD-1.78,95％ CI-2.36-1.20,P＜0.01),(MD-3.15,95％ CI-3.97-2.33,P＜0.01) respectively].There were no significant differences in blood transfusion,pancreatic fistula rate,and mortality between the two groups.Conclusions LDP is feasible and safe in treating pancreatic disease.When compared with ODP,LDP has the advantages of having less intraoperative blood loss,quicker recovery and more patients with spleen preservation.