保留十二指肠的胰头切除术与胰十二指肠切除术治疗胰头肿块型胰腺炎的Meta分析

摘要

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.%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.