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胰头癌胰十二指肠切除术中联合静脉切除的价值:一项荟萃分析。

The value of combined vein resection in pancreaticoduodenectomy for pancreatic head carcinoma: a meta-analysis.

作者信息

Peng Cheng, Zhou Di, Meng Lingjun, Cao Yanlong, Zhang Hanwen, Pan Zheng, Lin Chao

机构信息

Department of Hepatobiliary-Pancreatic Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130033, China.

Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China.

出版信息

BMC Surg. 2019 Jul 8;19(1):84. doi: 10.1186/s12893-019-0540-6.

Abstract

BACKGROUND

Although pancreaticoduodenectomy with vein resection (PDVR) is widely performed in selected patients with indications, its benefits remain controversial. In this meta-analysis, we evaluate the safety and efficacy of PDVR in comparison to standard pancreaticoduodenectomy (PD).

METHODS

We searched PubMed, Embase, and Cochrane as well as the Chinese National Knowledge Infrastructure, Weipu, and Wanfang databases for studies that evaluate the value of PVDR. The data of the patients who underwent PD or PDVR were analyzed using Review Manager and STATA software.

RESULTS

In comparison with the PD group, the PDVR group had a lower R0 resection rate and higher rates of complications such as biliary fistula, reoperation rate, delayed gastric emptying, cardiopulmonary abnormalities, hemorrhage, in-hospital mortality, 30-day mortality. The blood loss, duration of operation, total hospital stay is higher in PDVR group.

CONCLUSIONS

Compared to standard PD, PDVR was associated with a greater risk of some specific complications and increase the mortality rate, total hospital stay time, combine with vein resection have a lower R0 resection rate. Therefore, combine with vascular resection for pancreatic cancer needs to be carefully selected by the surgeon.

摘要

背景

尽管在有适应证的特定患者中广泛开展了联合静脉切除的胰十二指肠切除术(PDVR),但其益处仍存在争议。在这项荟萃分析中,我们评估了与标准胰十二指肠切除术(PD)相比,PDVR的安全性和有效性。

方法

我们检索了PubMed、Embase、Cochrane以及中国知网、维普和万方数据库,以查找评估PVDR价值的研究。使用Review Manager和STATA软件对接受PD或PDVR的患者数据进行分析。

结果

与PD组相比,PDVR组的R0切除率较低,胆瘘、再次手术率、胃排空延迟、心肺异常、出血、住院死亡率、30天死亡率等并发症发生率较高。PDVR组的失血量、手术时间、总住院时间更长。

结论

与标准PD相比,PDVR与某些特定并发症的风险更高相关,增加了死亡率、总住院时间,联合静脉切除的R0切除率较低。因此,外科医生对胰腺癌联合血管切除需要谨慎选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f344/6615269/7f7c6a7b58e3/12893_2019_540_Fig1_HTML.jpg

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