Li Bing-Qi, Qiao Yi-Xian, Li Jing, Yang Wen-Qiang, Guo Jun-Chao
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College , Beijing , China.
Department of Respiratory medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College , Beijing , China.
J Invest Surg. 2019 Nov;32(7):654-669. doi: 10.1080/08941939.2018.1449918. Epub 2018 Apr 11.
Spleen preservation distal pancreatectomy (SPDP) can be achieved by either splenic vessel preservation distal pancreatectomy (SVP-DP) or Warshaw technique (WT). Although studies comparing SVP-DP with WT have been reported, controversies exist. The aim of our study is to assess and compare the safety and feasibility of SVP-DP and WT. Two authors searched the online database independently till April 30, 2017. Data extraction and quality assessment were performed independently by two authors. Short- and long-term outcomes of WT and SVP-DP were evaluated. Subgroup analysis was performed on laparoscopic surgery. Odds ratios (OR) with 95% confidence interval (CI) and mean difference (MD) with 95% CI were estimated. A total of 664 patients from 11 retrospective cohort studies were included. Meta-analysis showed the WT group had a significantly higher incidence of splenic infarction (OR = 0.12; 95% CI: 0.07-0.20; < 0.00001) and gastric/epigastric varices (OR = 0.11; 95% CI: 0.05-0.24; < 0.00001). And more patients suffering from splenic infarction from WT group needed further splenectomy (OR = 0.13; 95% CI: 0.02-0.84; = 0.03). While there was no difference between the two procedures in terms of pancreatic fistula (OR = 0.55; 95% CI: 0.25-1.19; = 0.13), overall morbidity (OR = 0.87; 95% CI: 0.59-1.30; = 0.50) and hospital stay (MD = -0.45; 95% CI: -1.73-0.82; = 0.49). Due to relatively higher risk of postoperative splenic infarction, gastric/epigastric varices and Clavien-Dindo III-V complications, WT is not as safe as SVP-DP. However, well-conducted randomized clinical trials are still needed due to the limitations of current studies.
保留脾脏的远端胰腺切除术（SPDP）可通过保留脾血管的远端胰腺切除术（SVP-DP）或Warshaw技术（WT）来实现。尽管已有比较SVP-DP与WT的研究报道，但仍存在争议。我们研究的目的是评估和比较SVP-DP与WT的安全性和可行性。两位作者独立检索在线数据库直至2017年4月30日。数据提取和质量评估由两位作者独立进行。评估了WT和SVP-DP的短期和长期结果。对腹腔镜手术进行了亚组分析。估计了具有95%置信区间（CI）的比值比（OR）和具有95%CI的平均差（MD）。共纳入了来自11项回顾性队列研究的664例患者。荟萃分析显示，WT组脾梗死（OR = 0.12；95%CI：0.07 - 0.20；P < 0.00001）和胃/上腹部静脉曲张（OR = 0.11；95%CI：0.05 - 0.24；P < 0.00001）的发生率显著更高。并且WT组中更多发生脾梗死的患者需要进一步行脾切除术（OR = 0.13；95%CI：0.02 - 0.84；P = 0.03）。而在胰瘘（OR = 0.55；95%CI：0.25 - 1.19；P = 0.13）、总体并发症发生率（OR = 0.87；95%CI：0.59 - 1.30；P = 0.50）和住院时间（MD = -0.45；95%CI：-1.73 - 0.82；P = 0.49）方面，两种手术方法之间没有差异。由于术后脾梗死、胃/上腹部静脉曲张和Clavien-Dindo III - V级并发症的风险相对较高，WT不如SVP-DP安全。然而，由于当前研究的局限性，仍需要开展良好的随机临床试验。
