动脉优先入路与传统入路胰十二指肠切除术疗效比较的Meta分析

李昌旭; 袁晶晶; 王守乾; 唐朝辉; 徐露瑶; 王英超

doi:10.3969/j.issn.1001-5256.2020.08.025

动脉优先入路与传统入路胰十二指肠切除术疗效比较的Meta分析

DOI: 10.3969/j.issn.1001-5256.2020.08.025

1. 吉林大学第一医院肝胆胰外二科
2. 吉林大学第一医院心血管病科

基金项目:

吉林省教委科研基金(3D5196781428)；

详细信息

中图分类号: R657.5
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出版历程
- 出版日期: 2020-08-20

Clinical effect of artery-first approach versus traditional approach for pancreaticoduodenectomy:A Meta-analysis

The First Hospital of Jilin University

Research funding:

摘要

摘要:
目的比较动脉优先入路与传统入路胰十二指肠切除术的疗效。方法系统检索2003年1月1日至2020年1月31日PubMed、Embase、Cochrane Library、万方、知网、维普数据库中关于动脉优先入路和传统入路胰十二指肠切除术的随机对照研究和非随机对照研究,根据纳入与排除标准筛选文献。应用RevMan5.3统计软件进行Meta分析。对研究中的连续性变量及二分类变量分别采用均数差(MD)及比值比(OR)为效应分析统计量,各统计量分别计算95%可信区间(95%CI)。异质性不明显,采用固定效应模型;异质性明显,则使用随机效应模型。采用漏斗图检验是否存在发表偏倚。结果共纳入18篇文献,Meta分析结果显示:动脉优先入路胰十二指肠切除术与传统入路胰十二指肠切除术相比,可减少胰瘘、术后胃排空障碍、术后腹腔感染、局部复发、输血发生率并提高R0切除率[OR(95%CI)分别为0.68(0.48～0.94)、0.51(0.35～0.73)、0.50(0.30～0.84)、0.36(0.20～0.65)、0.20(0.07～0.59)、3.04(1.86～4.99),P值均<0.05]。胰...
- 胰十二指肠切除术 /
- 动脉优先入路 /
- 传统入路 /
- Meta分析(主题)
Abstract:
Objective To investigate the clinical effect of the artery-first approach versus the traditional approach for pancreaticoduodenectomy.Methods PubMed,Embase,Cochrane Library,Wanfang Data,CNKI,and VIP were searched for randomized controlled trials(RCTs) and non-RCTs on the artery-first approach versus the traditional approach for pancreaticoduodenectomy published from January1,2003 to January 31,2020,and the articles were screened according to inclusion and exclusion criteria.RevMan5.3 software was used to perform the meta-analysis.Mean difference and odds ratio(OR) were used to analyze continuous variables and binary variables,95%confidence interval(CI) was calculated for each variable.The fixed effects model was used for unobserved heterogeneity,and the random effects model was used for significant heterogeneity.Funnel plots were used to evaluate the absence or presence of publication bias.Results A total of 18 articles were included.The results of the meta-analysis showed that compared with pancreaticoduodenectomy with the traditional approach,pancreaticoduodenectomy with the artery-first approach reduced pancreatic fistula(OR=0.68,95% CI:0.48-0.94,P<0.05),delayed gastric emptying after surgery(OR=0.51,95% CI:0.35-0.73,P<0.05),postoperative abdominal infection(OR=0.50,95% CI:0.30-0.84,P<0.05),local recurrence(OR=0.36,95% CI:0.20-0.65,P<0.05),and incidence rate of blood transfusion(OR=0.20,95% CI:0.07-0.59,P<0.05) and increased R0 resection rate(OR=3.04,95% CI:1.86-4.99,P<0.05).Symmetric funnel plots were observed for the incidence rates of pancreatic fistula and delayed gastric emptying after surgery,suggesting that publication bias of the articles included had little influence on the results of this study.Conclusion The artery-first approach is as safe and feasible as the traditional approach for pancreaticoduodenectomy,and the artery-first approach is superior to the traditional approach in reducing some important postoperative complications and increasing R0 resection rate.Therefore,the artery-first approach holds promise for clinical application.
- pancreaticoduodenectomy /
- arterial first approach /
- traditional approach /
- Meta-analysis as topic

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参考文献(30)

[1] WHIPPLE AO,PARSONS WB,MULLINS CR. Treatment of carcinoma of the ampulla of vater[J]. Ann Surg,1935,102(4):763-779.

[2] WINTER JM,CAMERON JL,CAMPBELL KA,et al. 1423 pancreaticoduodenectomies for pancreatic cancer:A single-institution experience[J]. J Gastrointest Surg,2006,10(9):1199-1210; discussion 1210-1211.

[3] PESSAUX P,REGENET N,ARNAUD JP. Resection of the retroportal pancreatic lamina during a cephalic pancreaticoduodenectomy:First dissection of the superior mesenteric artery[J]. Ann Chir,2003,128(9):633-636.

[4] HORIGUCHI A,ISHIHARA S,ITO M,et al. Pancreatoduodenectomy in which dissection of the efferent arteries of the head of the pancreas is performed first[J]. J Hepatobiliary Pancreat Surg,2007,14(6):575-578.

[5] FIGUERAS J,CODINA-BARRERAS A,LPEZ-BEN S,et al.Cephalic duodenopancreatectomy in periampullary tumours. Dissection of the superior mesenteric artery as aninitial approach.Description of the technique and an assessment of our initial experience[J]. Cir Esp,2008,83(4):186-193.

[6] KAWAI M,TANI M,INA S,et al. CLIP method(preoperative CT image-assessed ligation of inferior pancreaticoduodenal artery)reduces intraoperative bleeding during pancreaticoduodenectomy[J]. World J Surg,2008,32(1):82-87.

[7] DUMITRASCU T,DAVID L,POPESCU I. Posterior versus standard approach in pancreatoduodenectomy:A case-match study[J]. Langenbecks Arch Surg,2010,395(6):677-684.

[8] ISHIZAKI Y,SUGO H,YOSHIMOTO J,et al. Pancreatoduodenectomy with or without early ligation of the inferior pancreatoduodenal artery:Comparison of intraoperative blood loss and short-term outcome[J]. World J Surg,2010,34(12):2939-2944.

[9] KUROSAKI I,MINAGAWA M,TAKANO K,et al. Left posterior approach to the superior mesenteric vascular pedicle in pancreaticoduodenectomy for cancer of the pancreatic head[J].JOP,2011,12(3):220-229.

[10] KAWABATA Y,TANAKA T,NISHI T,et al. Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma[J]. Eur J Surg Oncol,2012,38(7):574-579.

[11] AIMOTO T,MIZUTANI S,KAWANO Y,et al. Left posterior approach pancreaticoduodenectomy with total mesopancreas excision and circumferential lymphadenectomy around the superior mesenteric artery for pancreatic head carcinoma[J]. J Nippon Med Sch,2013,80(6):438-445.

[12] SHAH OJ,GAGLOO MA,KHAN IJ,et al. Pancreaticoduodenectomy:A comparison of superior approach with classical Whipple’s technique[J]. Hepatobiliary Pancreat Dis Int,2013,12(2):196-203.

[13] GUNDARA JS,WANG F,ALVARADO-BACHMANN R,et al.The clinical impact of early complete pancreatic head devascularisation during pancreatoduodenectomy[J]. Am J Surg,2013,206(4):518-525.

[14] ZHOU HY,WANG Y,ZHANG J,et al. Retrograde vs conventional dissection technique in pancreaticoduodenectomy:A pilot study[J]. JAMA Surg,2014,149(6):604-607.

[15] INOUE Y,SAIURA A,YOSHIOKA R,et al. Pancreatoduodenectomy with systematic mesopancreas dissection using a supracolic anterior artery-first approach[J]. Ann Surg,2015,262(6):1092-1101.

[16] PEDZIWIATR M,PISARSKA M,MACZAK P,et al. Laparoscopic uncinate process first pancreatoduodenectomy-feasibility study of a modified ‘artery first’approach to pancreatic head cancer[J]. Langenbecks Arch Surg,2017,402(6):917-923.

[17] IEDE K,NAKAO A,OSHIMA K,et al. Early ligation of the dorsal pancreatic artery with a mesenteric approach reduces intraoperative blood loss during pancreatoduodenectomy[J]. J Hepatobiliary Pancreat Sci,2018,25(7):329-334.

[18] LI XD,WANG SJ,ZHOU YM,et al. Application of the arteryfirst approach in the radical pancreaticoduodenectomy[J].Chin J Dig Surg,2016,15(6):628-633.(in Chinese)李秀东，王双佳，周彦明，等．动脉优先入路在根治性胰十二指肠切除术中的应用价值[J]．中华消化外科杂志，2016,15(6):628-633.

[19] JIN G,ZHENG KL,GUO SW,et al. Analysis on the clinical therapeutic effects of arterial first approach pancreaticoduodenectomy in the treatment of borderline resectable pancreatic adenocarcinoma[J]. Chin J Surg,2017,55(12):909-915.(in Chinese)金钢，郑楷炼，郭世伟，等．动脉先行路径胰十二指肠切除治疗交界性可切除胰腺癌的临床疗效分析[J]．中华外科杂志，2017,55(12):909-915.

[20] MA CY,ZHU F,WANG M,et al. Clinical value of arterial first approach in laparoscopic pancreaticoduodenectomy[J]. Chin J Dig Surg,2017,16(8):832-838.(in Chinese)马春阳，朱峰，王敏，等．动脉优先入路在腹腔镜胰十二指肠切除术中的临床价值[J]．中华消化外科杂志，2017,16(8):832-838.

[21] LI QC,XUE JH,LI WG. Clinical value of arterial first approach in laparoscopic pancreaticoduodenectomy for periampullary tumor[J]. Chin J Postgraduates Med,2019,42(1):14-18.(in Chinese)李青春，薛军花，李文革．壶腹周围癌行腹腔镜胰十二指肠切除术时动脉优先入路的应用探讨[J]．中国医师进修杂志，2019,42(1):14-18.

[22] HOU DF,BU XM. Influencing factors for delayed gastric emptying after pancreaticoduo-denectomy and its prevention and treatment[J]. J Clin Hepatol,2018,34(3):663-666.(in Chinese)侯登峰，卜献民．胰十二指肠切除术后胃排空延迟的影响因素及防治[J]．临床肝胆病杂志，2018,34(3):663-666.

[23] ZHENG KL,WANG H,NI CM,et al. Clinical efficacy of pancreaticoduodenectomy using artery first approach and prior portal vein-superior mesenteric vein shunting and reconstruction for complicated pancreatic head tumors[J]. Chin J Dig Surg,2018,17(7):703-710.(in Chinese)郑楷炼，王欢，倪晨明，等．动脉先行路径联合预先门静脉-肠系膜上静脉分流重建胰十二指肠切除术治疗复杂胰头部肿瘤的临床疗效[J]．中华消化外科杂志，2018,17(7):703-710.

[24] GAO WT,JIANG KR,WU JL,et al. Application of artery first approach for pancreatic-odudenectomy[J]. Chin J Bases Clin Gen Surg,2014,21(7):802-808.(in Chinese)高文涛，蒋奎荣，吴峻立，等．动脉优先入路在胰十二指肠切除术中的技术要点[J]．中国普外基础与临床杂志，2014,21(7):802-808.

[25] CHAMBERLAIN RS,EL-SEDFY A,RAJKUMAR D. Aberrant hepatic arterial anatomy and the whipple procedure:Lessons learned[J]. Am Surg,2011,77(5):517-526.

[26] PESSAUX P,ROSSO E,PANARO F,et al. Preliminary experience with the hanging maneuver for pancreaticoduodenectomy[J]. Eur J Surg Oncol,2009,35(9):1006-1010.

[27] QIN RY,MA CY,ZHU F,et al. Application of the arterial approach in laparoscopic pancreatoduodenectomy[J]. Chin J Dig Surg,2017,16(8):791-796.(in Chinese)秦仁义，马春阳，朱峰，等．动脉入路在腹腔镜胰十二指肠切除术中的运用[J]．中华消化外科杂志，2017,16(8):791-796.

[28] BERNARD AC,DAVENPORT DL,CHANG PK,et al. Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality,surgical-site infection,pneumonia,and sepsis in general surgery patients[J]. J Am Coll Surg,2009,208(5):931-937; discussion938-939.

[29] GALL TM,JACOB J,FRAMPTON AE,et al. Reduced dissemination of circulating tumor cells with no-touch isolation surgical technique in patients with pancreatic cancer[J]. JAMA Surg,2014,149(5):482-485.

[30] CHEN ZC,LIU J. Current status and perspectives of laparoscopic pancreaticoduodenectomy[J]. J Clin Hepatol,2018,34(9):2027-2032.(in Chinese)陈志诚，刘军．腹腔镜胰十二指肠切除术的应用现状及展望[J]．临床肝胆病杂志，2018,34(9):2027-2032.

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