CAJ | 학술논문

目的系统评价腹腔镜与开腹行胰体尾切除术的安全性.方法于Cochrane library、MEDLINE、EMbase、Google学术、CNKI等数据库检索比较腹腔镜与开腹胰体尾切除术的随机对照试验(RCT)、临床对照试验(CCT)或回顾性病例对照研究.按照纳入和排除标准筛选文献以及进行Jadad质量评价后,再采用Cochrane协作网专用软件RevMan 5.0对数据进行Meta分析.结果最终纳入21篇文献,共2797例.其中1 150例行腹腔镜胰体尾切除术(LDP),1 647例行开腹胰体尾切除术(ODP).Meta分析结果显示:(1)术后总并发症发生率:20个试验(n=2 597)表明,LDP与ODP的术后总并发症发生率差异有统计学意义,LDP组为33.90％低于ODP组的46.80％[RR=0.76,95％CI (0.69～0.84),P＜0.01];(2)围手术期病死率:8个试验(n=1 869)表明,LDP(4/703)与ODP(18/1 166)的围手术期病死率差异无统计学意义[RR=0.51,95％ CI(0.21～1.24),P＞0.05];(3)胰漏发生率:20个试验(n=2757)表明,LDP(168/1 132)与ODP(281/1 625)两者胰瘘发生率差异无统计学意义[RR =0.89,95％ CI(0.75 ～ 1.06),P＞0.05];(4)切口感染率:11个试验(n=1 840)表明,LDP与ODP的切口感染率差异有统计学意义,LDP为3.24％低于ODP的10.85％ [RR =0.34,95％ CI(0.23 ～0.52),P＜0.01];(5)肺部并发症发生率、腹腔感染率、尿路感染率、术后出血率、假性囊肿发生率、肠梗阻发生率和腹水发生率两组差异均无统计学意义.结论腹腔镜胰体尾切除术较传统开腹手术具有术后总并发症发生率低、切口感染少等优点,且术后病死率、胰瘘发生率与开腹手术差异无统计学意义,是安全、可行的手术方式.
목적 계통평개복강경여개복행이체미절제술적안전성.방법 우Cochrane library、MEDLINE、EMbase、Google학술、CNKI등수거고검색비교복강경여개복이체미절제술적수궤대조시험(RCT)、림상대조시험(CCT)혹회고성병례대조연구.안조납입화배제표준사선문헌이급진행Jadad질량평개후,재채용Cochrane협작망전용연건RevMan 5.0대수거진행Meta분석.결과 최종납입21편문헌,공2797례.기중1 150례행복강경이체미절제술(LDP),1 647례행개복이체미절제술(ODP).Meta분석결과현시:(1)술후총병발증발생솔:20개시험(n=2 597)표명,LDP여ODP적술후총병발증발생솔차이유통계학의의,LDP조위33.90％저우ODP조적46.80％[RR=0.76,95％CI (0.69～0.84),P＜0.01];(2)위수술기병사솔:8개시험(n=1 869)표명,LDP(4/703)여ODP(18/1 166)적위수술기병사솔차이무통계학의의[RR=0.51,95％ CI(0.21～1.24),P＞0.05];(3)이루발생솔:20개시험(n=2757)표명,LDP(168/1 132)여ODP(281/1 625)량자이루발생솔차이무통계학의의[RR =0.89,95％ CI(0.75 ～ 1.06),P＞0.05];(4)절구감염솔:11개시험(n=1 840)표명,LDP여ODP적절구감염솔차이유통계학의의,LDP위3.24％저우ODP적10.85％ [RR =0.34,95％ CI(0.23 ～0.52),P＜0.01];(5)폐부병발증발생솔、복강감염솔、뇨로감염솔、술후출혈솔、가성낭종발생솔、장경조발생솔화복수발생솔량조차이균무통계학의의.결론 복강경이체미절제술교전통개복수술구유술후총병발증발생솔저、절구감염소등우점,차술후병사솔、이루발생솔여개복수술차이무통계학의의,시안전、가행적수술방식.
Objective To systematically evaluate the safety of laparoscopic distal pancreatectomy (LDP) compared with open distal pancreatectomy (ODP).Methods Databases including Cochrane library,MEDLINE,EMbase,Google Scholar and Chinese National Knowledge Infrastructure were searched to enroll randomized clinical trials (RCT),controlled clinical trials (CCT) or retrospective case-control studies to compare LDP with ODP.All articles received quality assessment according to the inclusion and exclusion criteria,then the selected indices were analyzed using the Review Manager Version 5.0 software (The Cochrane Collaboration,Oxford,United Kingdom).Results 21 manuscripts with a total of 2 797 patients were enrolled.1 150 patients underwent LDP and the remaining 1 647 patients underwent ODP.In 20 studies (n =2 597),the total postoperative complication rates were 33.90％ for the LDP group versus 46.80％ for the ODP group [RR =0.76,95％ CI(0.69 ～ 0.84),P ＜ 0.01].In 8 studies (n =1 869) there was no significant difference [RR =0.51,95％ CI(0.21 ～ 1.24),P ＞0.05] in the perioperative mortality between LDP (4/703) and ODP (18/1 166).In 20 studies (n =2 757) there was no significant difference [RR =0.89,95％ CI(0.75 ～ 1.06),P ＞ 0.05] in the pancreatic fistula rate between LDP (168/1 132) and ODP (281/1 625).In 11 studies (n =1 840) the wound infection rate of LDP (3.24％) was significantly lower than ODP (10.85％) [RR =0.34,95％ CI(0.23 ～ 0.52),P ＜ 0.01].No significance was found between the two groups in the rates of pulmonary complications,peritoneal infection,urinary tract infection,postoperative bleeding,pseudocyst formation,intestinal obstruction and ascites formation between LDP and ODP.Conclusions When compared with the traditional open procedure,LDP has the advantages of significantlylower rates of postoperative complication and wound infection.There were no significant differences in postoperative mortality,and pancreatic fistula rate between LDP and ODP.This meta-analysis suggests that LDP is a safe and feasible operative method.