中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2014年
9期
668-674
,共7页
蒋康怡%吴柯%廖玉平%涂兵
蔣康怡%吳柯%廖玉平%塗兵
장강이%오가%료옥평%도병
胰腺炎%胰十二指肠切除术%保留十二指肠的胰头切除术%荟萃分析
胰腺炎%胰十二指腸切除術%保留十二指腸的胰頭切除術%薈萃分析
이선염%이십이지장절제술%보류십이지장적이두절제술%회췌분석
Pancreatitis%Pancreaticoduodenectomy%Duodenum-preserving pancreatic head resection%Meta analysis
目的 探讨保留或不保留幽门的胰十二指肠切除术(PPPD/PD)与保留十二指肠的胰头切除术(DPPHR)治疗胰头肿块型胰腺炎的安全性和有效性.方法 系统检索Medline数据库、EMBase数据库、Biosis数据库、COCHRANELibrary、Science Citation Index数据库、中国生物医学文献数据库、中国期刊全文数据库、万方数据库、维普中文科技期刊数据库,选取随机对照试验和前瞻性临床对照试验,参考Cochrane Handbook5.1偏倚风险评估工具评估偏倚风险.应用Review Manager 5.2对两类术式安全性和有效性相关参数进行统计分析.结果 共纳入7篇文献,共计381例患者.DPPHR组与PPPD/PD组比较,在围术期死亡率(RD =0.01,P=0.51)、术后出血(RD=-0.01,P=0.72)、胰瘘(RD=-0.01,P=0.59)、胃排空延迟(RD=-0.15,P=0.10)、完全腹痛缓解(RR=1.06,P=0.32)、总体生活质量评分(WMD=10.31,P=0.19)等方面二者差异无统计学意义;在围术期总并发症发生率(RR =0.60,P=0.008)、手术时间(WMD=-71.60,P=0.03)、术后住院时间(WMD=-3.95,P＜0.01)、体重增加(WMD=3.68,P＜0.01)及工作恢复(RR=1.38,P=0.008)等方面DPPHR组优于PPPD/PD组,差异有统计学意义.结论 DPPHR在减少术后并发症、缩短手术及住院时间、体重恢复及工作恢复等方面优于PPPD/PD,有利于提高胰头肿块型慢性胰腺炎患者的生活质量.
目的 探討保留或不保留幽門的胰十二指腸切除術(PPPD/PD)與保留十二指腸的胰頭切除術(DPPHR)治療胰頭腫塊型胰腺炎的安全性和有效性.方法 繫統檢索Medline數據庫、EMBase數據庫、Biosis數據庫、COCHRANELibrary、Science Citation Index數據庫、中國生物醫學文獻數據庫、中國期刊全文數據庫、萬方數據庫、維普中文科技期刊數據庫,選取隨機對照試驗和前瞻性臨床對照試驗,參攷Cochrane Handbook5.1偏倚風險評估工具評估偏倚風險.應用Review Manager 5.2對兩類術式安全性和有效性相關參數進行統計分析.結果 共納入7篇文獻,共計381例患者.DPPHR組與PPPD/PD組比較,在圍術期死亡率(RD =0.01,P=0.51)、術後齣血(RD=-0.01,P=0.72)、胰瘺(RD=-0.01,P=0.59)、胃排空延遲(RD=-0.15,P=0.10)、完全腹痛緩解(RR=1.06,P=0.32)、總體生活質量評分(WMD=10.31,P=0.19)等方麵二者差異無統計學意義;在圍術期總併髮癥髮生率(RR =0.60,P=0.008)、手術時間(WMD=-71.60,P=0.03)、術後住院時間(WMD=-3.95,P＜0.01)、體重增加(WMD=3.68,P＜0.01)及工作恢複(RR=1.38,P=0.008)等方麵DPPHR組優于PPPD/PD組,差異有統計學意義.結論 DPPHR在減少術後併髮癥、縮短手術及住院時間、體重恢複及工作恢複等方麵優于PPPD/PD,有利于提高胰頭腫塊型慢性胰腺炎患者的生活質量.
목적 탐토보류혹불보류유문적이십이지장절제술(PPPD/PD)여보류십이지장적이두절제술(DPPHR)치료이두종괴형이선염적안전성화유효성.방법 계통검색Medline수거고、EMBase수거고、Biosis수거고、COCHRANELibrary、Science Citation Index수거고、중국생물의학문헌수거고、중국기간전문수거고、만방수거고、유보중문과기기간수거고,선취수궤대조시험화전첨성림상대조시험,삼고Cochrane Handbook5.1편의풍험평고공구평고편의풍험.응용Review Manager 5.2대량류술식안전성화유효성상관삼수진행통계분석.결과 공납입7편문헌,공계381례환자.DPPHR조여PPPD/PD조비교,재위술기사망솔(RD =0.01,P=0.51)、술후출혈(RD=-0.01,P=0.72)、이루(RD=-0.01,P=0.59)、위배공연지(RD=-0.15,P=0.10)、완전복통완해(RR=1.06,P=0.32)、총체생활질량평분(WMD=10.31,P=0.19)등방면이자차이무통계학의의;재위술기총병발증발생솔(RR =0.60,P=0.008)、수술시간(WMD=-71.60,P=0.03)、술후주원시간(WMD=-3.95,P＜0.01)、체중증가(WMD=3.68,P＜0.01)급공작회복(RR=1.38,P=0.008)등방면DPPHR조우우PPPD/PD조,차이유통계학의의.결론 DPPHR재감소술후병발증、축단수술급주원시간、체중회복급공작회복등방면우우PPPD/PD,유리우제고이두종괴형만성이선염환자적생활질량.
Objective To compare the safety and effectiveness of DPPHR with PPPD/PD for treating chronic pancreatitis with an inflammatory mass in the head of pancreas.Methods The relative data bases such as Medline,EMBase,Biosis,COCHRANE Library,Science Citation Index,SinoMed,Chinese Journal Full-text Database,Wangfang,CNKI were searched systematically,researchers selected randomized controlled trials(RCT) and prospective clinical controlled trials(CCT).The assessment of the bias risk of the included trials was according to the assessing tools suggested by Cochrane Handbook 5.1.The Review Manage 5.2 was used to perform the statistical analysis.Results In total,5 RCTs and 2 CCTs were included,381 patients involved.Comparing with PPPD/PD procedure,DPPHR has no significant difference in terms of the mortality of perioperative period (RD =0.01,P =0.51),the incidence of bleeding (RD =-0.01,P =0.72),pancreatic fistula (RD =-0.01,P =0.59) and delayed gastric emptying (RD =-0.15,P =0.10),the ration of complete pain relief after operation(RR =1.06,P =0.32) and the score of global quality of life(WMD =10.31,P =0.19).While DPPHR had significant superiorities in terms of the total morbidity of perioperative period (RR =0.60,P =0.008),the duration of the operations (WMD =-71.60,P =0.03),the postoperative hospitalization duration (WMD =-3.95,P ＜ 0.01),weight gain (WMD =3.68,P ＜ 0.01),occupational rehabilitation after the operations (RR =1.38,P =0.008).Conclusions In terms of reducing the morbidity of perioperative period,shortening the duration of the operations and the postoperative hospitalization duration,weight gain,occupational rehabilitation after the operations,the DPPHR is more favorable for improving patients' life qualities comparing with PPPD/PD.
