Department of General and Visceral Surgery, University of Ulm, Germany; Center of Oncologic, Endocrine and Minimal Invasive Surgery, Donauklinikum Neu-UIm, Germany.
Nagoya Central Hospital, Nagoya University, Japan.
Pancreatology. 2015 Mar-Apr;15(2):167-78. doi: 10.1016/j.pan.2015.01.009. Epub 2015 Feb 7.
Potential benefits of local extirpation of benign pancreatic head tumors are tissue conservation of pancreas, stomach, duodenum and common bile duct (CBD) and maintenance of pancreatic functions.
Medline/PubMed, Embase and Cochrane Library databases were searched to identify studies applying duodenum-preserving total or partial pancreatic-head resection (DPPHRt/p) and reporting short- and long-term outcomes. Twenty-four studies, including 416 patients who underwent DPPHRt/p, were identified for systematic analysis. The meta-analysis was based on 10 prospective controlled and 4 retrospective controlled cohort studies, comparing 293 DPPHRt/p resections with 372 pancreato-duodenectomies (PD).
RESULTS, SYSTEMATIC ANALYSIS: Of 416 patients, 75.7% underwent total and 24.3% partial head resection, while 47.1% included segmentectomy of duodenum and CBD. The most common pathology was cystic neoplasm (65.8%) and endocrine tumors (13.4%). The frequencies of severe postoperative complications of 8.8%, pancreatic fistula of 19.2%, re-operation of 1.7% and hospital mortality of 0.48%, indicate a low level of early post-operative complications.
META-ANALYSIS: DPPHRt/p significantly preserved the level of exocrine (IV = -0.67, 95% CI -0.98 to -0.35, p = 0.0001) and endocrine (IV = 18.20, fixed, 95% CI -0.92 to 25.48, p = 0.0001) pancreatic functions compared to PD when the pre- and postoperative functional status in both groups are analyzed. There were no significant differences between DPPHRt/p and PD in frequency of pancreatic fistula, delayed gastric emptying or hospital mortality.
DPPHRt/p for benign neoplasms and neuro-endocrine tumors of the pancreatic head is associated with a low level of early-postoperative complications and a better conservation of exocrine and endocrine functions.
局部切除良性胰头部肿瘤的潜在优势在于保留胰腺、胃、十二指肠和胆总管（CBD）的组织，维持胰腺功能。
通过 Medline/PubMed、Embase 和 Cochrane 图书馆数据库检索，以确定应用保留十二指肠的胰头全切除或部分切除（DPPHRt/p）并报告短期和长期结果的研究。对 24 项研究进行系统分析，这些研究包括 416 例接受 DPPHRt/p 的患者。该荟萃分析基于 10 项前瞻性对照研究和 4 项回顾性对照队列研究，将 293 例 DPPHRt/p 切除术与 372 例胰十二指肠切除术（PD）进行比较。
416 例患者中，75.7%行全胰头切除术，24.3%行部分胰头切除术，47.1%行十二指肠和 CBD 节段切除术。最常见的病理类型为囊性肿瘤（65.8%）和内分泌肿瘤（13.4%）。术后严重并发症发生率为 8.8%，胰瘘发生率为 19.2%，再次手术率为 1.7%，住院死亡率为 0.48%，表明早期术后并发症发生率较低。
与 PD 相比，DPPHRt/p 可显著保留外分泌（IV=-0.67，95%CI-0.98 至-0.35，p=0.0001）和内分泌（IV=18.20，固定，95%CI-0.92 至 25.48，p=0.0001）胰腺功能，当分析两组的术前和术后功能状态时。DPPHRt/p 与 PD 在胰瘘、胃排空延迟或住院死亡率方面无显著差异。
DPPHRt/p 治疗胰头部良性肿瘤和神经内分泌肿瘤，具有较低的早期术后并发症发生率和更好的外分泌和内分泌功能保留。
