CAJ | 학술논문

目的探讨保留十二指肠的胰头切除术(DPPHR)与保留幽门的胰十二指肠切除术(PPPD)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、Biosis、The Cochrane Library、Science Citation Index Database、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.选取相关临床随机对照试验,参考Cochrane Handbook的偏倚风险评估工具评估偏倚风险.应用Review Manager 5.2统计软件对两类术式安全性和有效性相关参数进行统计分析.结果纳入的7篇文献共226例患者.DPPHR组与PPPD组比较,在术后总并发症发生率、术后住院时间、疼痛完全缓解率、胰漏发生率、胰腺外分泌不足以及术后5～7、14～15年随访症状评分等方面差异无统计学意义(P＞0.05).在手术时间、术中用血量、胃排空延迟发生率、工作恢复、体重恢复、术后1～2年总体生活质量评分、术后5～7年术后疼痛发生率、身体机能评分、术后14～15年随访症状评分等方面DPPHR组优于PPPD组,差异有统计学意义(P＜0.05).结论 DPPHR在减少术中用血、缩短手术时间、胃排空延迟、工作恢复、体重恢复及身体机能等方面优于PPPD,有利于提高胰头肿块型慢性胰腺炎患者的生活质量.
목적 탐토보류십이지장적이두절제술(DPPHR)여보류유문적이십이지장절제술(PPPD)치료이두종괴형이선염적안전성화유효성.방법 계통검색Medline、Biosis、The Cochrane Library、Science Citation Index Database、중국생물의학문헌수거고、중국기간전문수거고、만방수거고、유보중문과기기간수거고.선취상관림상수궤대조시험,삼고Cochrane Handbook적편의풍험평고공구평고편의풍험.응용Review Manager 5.2통계연건대량류술식안전성화유효성상관삼수진행통계분석.결과 납입적7편문헌공226례환자.DPPHR조여PPPD조비교,재술후총병발증발생솔、술후주원시간、동통완전완해솔、이루발생솔、이선외분비불족이급술후5～7、14～15년수방증상평분등방면차이무통계학의의(P＞0.05).재수술시간、술중용혈량、위배공연지발생솔、공작회복、체중회복、술후1～2년총체생활질량평분、술후5～7년술후동통발생솔、신체궤능평분、술후14～15년수방증상평분등방면DPPHR조우우PPPD조,차이유통계학의의(P＜0.05).결론 DPPHR재감소술중용혈、축단수술시간、위배공연지、공작회복、체중회복급신체궤능등방면우우PPPD,유리우제고이두종괴형만성이선염환자적생활질량.
Objective To compare the safety and effectiveness of duodenum-preserving pancreatic head resection (DPPHR) with pylorus-preserving pancreaticoduodenectomy (PPPD) in the treatment of chronic pancreatitis with a pancreatic head mass.Methods Medline,Biosis,Cochrane Library,Science Citation Index Database,CBM Database,Wan Fang and CNKI were searched systematically.The bias risk of the included trials was assessed according to the assessing tools as suggested by the Cochrane Handbook.Review Manage 5.2 was used to perform the statistical analysis.Results 7 RCTs with 226 patients were included in the meta-analysis which showed that there were no significant differences between PPPD and DPPHR in overall postoperative morbidity,postoperative hospital stay,complete pain relief,pancreatic fistula,exocrine insufficiency,symptom score at 5 to 7-year follow-up,and quality of life score at 14 to 15-year follow-up (P ＞ 0.05).While DPPHR had significant superiorities in operation time,blood replacement,delayed gastric emptying,occupational rehabilitation after the operations,weight gain,quality of life score at 1 to 2-year follow-up,symptom score at 5 to 7-year follow-up,and physical functioning score at 14 to 15-year follow-up.Conclusions DPPHR is more favourable than PPPD in reducing the use of blood replacement,shortening operation time,delayed gastric emptying,occupational rehabilitation after the operations,weight gain,physical functioning,and in improving quality of life of patients.