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首页> 外文期刊>The British Journal of Surgery >Meta‐analysis of an artery‐first approach versus versus standard pancreatoduodenectomy on perioperative outcomes and survival
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Meta‐analysis of an artery‐first approach versus versus standard pancreatoduodenectomy on perioperative outcomes and survival

机译:动脉 - 第一次方法的荟萃分析与围手术期结果和存活率的标准胰蛋白酶切除术

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摘要

Background The aim of this systematic review and meta‐analysis was to evaluate perioperative outcomes and survival in patients undergoing an artery‐first approach to pancreatoduodenectomy in comparison with those having standard pancreatoduodenectomy. Methods A systematic search of PubMed, MEDLINE, Embase and the Cochrane Database of Systematic Reviews was performed in accordance with PRISMA guidelines. Comparative studies including patients who underwent artery‐first pancreatoduodenectomy and standard pancreatoduodenectomy were analysed. Results Seventeen studies were included in the final analysis. There were 16 retrospective cohort or case–control studies and one RCT. A total of 1472 patients were included in the meta‐analysis, of whom 771 underwent artery‐first pancreatoduodenectomy and 701 had standard pancreatoduodenectomy. Intraoperative blood loss (mean difference –389 ml; P ??0·001) and the proportion of patients requiring intraoperative transfusion (10·6 per cent (54 of 508) versus 40·1 per cent (186 of 464); P ??0·001) were significantly lower in the artery‐first group. Although rates of perioperative mortality were comparable between the two groups, perioperative morbidity (35·5 per cent (263 of 741) versus 44·3 per cent (277 of 625); P = 0·002), and the incidence of grade B/C pancreatic fistula (7·4 per cent (26 of 353) versus 12·8 per cent (42 of 327); P = 0·031) were significantly lower in the artery‐first group. The R0 resection rate (75·8 per cent (269 of 355) versus 67·0 per cent (280 of 418); P ??0·001) and overall survival (hazard ratio 0·72, 95 per cent c.i. 0·60 to 0·87; P ??0·001) were significantly higher in the artery‐first group. Conclusion The artery‐first approach to pancreatoduodenectomy may be associated with improved perioperative outcomes and survival.
机译:背景技术这种系统评价和荟萃分析的目的是评估经历动脉 - 首先对胰腺转录术治疗的患者的围手术期结果和生存率,与标准胰蛋白酶切除术的患者相比。方法根据Prisma准则,对系统评论的PubMed,Medline,Embase和Cochrane数据库进行系统搜索。分析了对比较研究,包括接受动脉 - 第一胰腺转霉病切除术和标准胰蛋白酶切除术的患者。结果最终分析中包含十七项研究。有16个回顾性队列或病例对照研究和一个RCT。在荟萃分析中共有1472名患者,其中771个接受动脉 - 首先胰蛋白酶切除术,701例具有标准的胰腺转录切除术。术中失血(平均差异-389ml;p≤≤0·001),并且需要术中输血的患者的比例(10·6%(508个)与40·1%(186个中的464个);在动脉第一组中,p?&Δ0·001)显着降低。虽然两组之间的围手术期死亡率的速率相当,但围手术期发病率(35·5%(263%)与44·3%(277%的625); P = 0·002),B等级的发病率/ C胰瘘(7·4%(263个)与12·8%(327个中的42%);动脉 - 第一组显着降低P = 0·031)。 R0切除率(75·8%(269%)与67·0%(280%(共418个);p≤≤0·001)和整体存活(危险比0·72,95%ci 0·60至0·87; p?α& 0·001)在动脉第一组显着高。结论胰腺转化术的动脉 - 首先方法可能与改善的围手术期结果和存活相关。

著录项

  • 来源
    《The British Journal of Surgery》 |2018年第6期|共9页
  • 作者单位

    Department of Surgery Faculty of Medical and Health SciencesUniversity of AucklandAuckland New;

    Hepatobiliary and Oesophagogastric Unit Division of Surgery and Perioperative MedicineFlinders;

    Department of Surgery Faculty of Medical and Health SciencesUniversity of AucklandAuckland New;

    Gastrointestinal and Hepatopancreatobiliary Unit Department of Surgical OncologyTata Memorial;

    Department of Surgery Faculty of Medical and Health SciencesUniversity of AucklandAuckland New;

    Department of Surgery Faculty of Medical and Health SciencesUniversity of AucklandAuckland New;

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  • 正文语种 eng
  • 中图分类 外科学;
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