CAJ | 학술논문

目的：评价保留幽门的胰十二指肠切除术（PPPD）治疗壶腹周围癌的疗效及安全性。方法检索1980年1月1日至2013年11月18日Cochrane libriary、Embase、Pubmed、Ovid、Web of science及中国生物医学文献数据库（CBM）等数据库公开发表的比较PPPD和胰十二指肠切除术（PD）治疗壶腹周围癌的随机对照研究，通过纳入和排除标准筛选文献，采用Cochrane 系统评价员手册中RCT的偏倚风险评价标准评价纳入研究的方法学质量，分析软件为RevMan5．2。结果共有7篇随机对照研究被纳入。结果显示，与PD组相比，PPPD组的术中出血量（MD＝－200．10，95％ CI：－400．66～0．46，P＝0．05）、手术时间（MD＝－46．55，95％ CI：－91．02～－2．07，P＝0．04）及围手术期输血量（MD＝－0．89，95％ CI：－1．59～－0．19，P＝0．01）均明显减少，而胰漏、胆漏、肠瘘、腹腔脓肿、术后出血、伤口感染及手术死亡率等并发症以及生存率的差异无统计学意义（均P＞0．05）。结论 PPPD治疗壶腹周围癌疗效确切且安全性好，能够获得与PD相当的生存率。
목적：평개보류유문적이십이지장절제술（PPPD）치료호복주위암적료효급안전성。방법검색1980년1월1일지2013년11월18일Cochrane libriary、Embase、Pubmed、Ovid、Web of science급중국생물의학문헌수거고（CBM）등수거고공개발표적비교PPPD화이십이지장절제술（PD）치료호복주위암적수궤대조연구，통과납입화배제표준사선문헌，채용Cochrane 계통평개원수책중RCT적편의풍험평개표준평개납입연구적방법학질량，분석연건위RevMan5．2。결과공유7편수궤대조연구피납입。결과현시，여PD조상비，PPPD조적술중출혈량（MD＝－200．10，95％ CI：－400．66～0．46，P＝0．05）、수술시간（MD＝－46．55，95％ CI：－91．02～－2．07，P＝0．04）급위수술기수혈량（MD＝－0．89，95％ CI：－1．59～－0．19，P＝0．01）균명현감소，이이루、담루、장루、복강농종、술후출혈、상구감염급수술사망솔등병발증이급생존솔적차이무통계학의의（균P＞0．05）。결론 PPPD치료호복주위암료효학절차안전성호，능구획득여PD상당적생존솔。
Objective To evaluate the efficacy and safety of pylorus-preserving pancreatico-duodenectomy (PPPD) in the treatment of periampullary adenocarcinoma by using Meta-analysis. Methods From January 1, 1980 to November 8, 2013, the articles of randomized controlled trials (RCTs) about PPPD versus PD in the treatment of periampullary adenocarcinoma were collected from Cochrane Libriary, Embase, PubMed, Ovid, Web of science and CBM etc. The methodological quality of the included studies was evaluated according to Cochrane system review valuator handbook of risk of bias standards. Meta-analysis was performed by RevMan 5.2 software. Results Seven RCTs were enrolled in the meta-analysis. Compared to PD group, PPPD group was associated with significantly less intraoperative blood loss (MD=-200.10, 95% CI:-400.66 to 0.46, P=0.05), shorter operation time (MD=-46.55, 95%CI:-91.02 to -2.07, P=0.04), and less postoperative blood transfusion (MD=-0.89, 95% CI:-1.59 to -0.19, P=0.01). There were no significant differences between the PPPD and PD group in pancreatic fistula, biliary fistula, intestinal fistula, abdominal abscess, postoperative bleeding, wound infection, relaparotomy, mortality and survival rate (all P>0.05). Conclusions PPPD in the treatment of the periampullary adenocarcinoma is safe and effective with similar survival of PD surgery. PPPD can reduce operative time, intraoperative blood loss, transfusion and does not increase the surgery complications as compared to PD.