Montorsi Roberto M, Francken Michiel F G, Boermeester Marja A, Busch Olivier R, Daams Freek, Hackert Thilo, Haen Roel, Hollmann Markus W, van Santvoort Hjalmar C, Besselink Marc G
Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.
Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.
BJS Open. 2024 Dec 30;9(1). doi: 10.1093/bjsopen/zrae135.
Patients with painful chronic pancreatitis combined with a dilated main pancreatic duct and a normal size pancreatic head are treated according to guidelines by lateral pancreaticojejunostomy (LPJ). This systematic review compared outcomes of minimally invasive LPJ and open LPJ.
From 1 January 2000 until 13 November 2023, series reporting on minimally invasive LPJ and open LPJ in patients with symptomatic chronic pancreatitis were included. This study was structured in accordance with the PRISMA guidelines. The primary outcome was intraoperative and postoperative complications. Secondary outcomes included long-term clinical outcomes.
Overall, 19 retrospective studies were included. Morbidity rate ranged from 0% to 57% after minimally invasive LPJ versus 4% to 68% after open LPJ (median: 25, i.q.r.: 23). Length of hospital stay ranged from 5 to 7 days after minimally invasive LPJ and from 6 to 16 days after open LPJ. The rate of pain relief ranged from 62% to 91% after open LPJ (median: 78.5, i.q.r.: 23) and from 71% to 100% (median: 82.5, i.q.r.: 12.5) after minimally invasive LPJ respectively. New-onset endocrine insufficiency ranged from 21% to 22% in minimally invasive LPJ and 19% to 26% after open LPJ. New-onset exocrine insufficiency was shown in 11% to 27% in minimally invasive LPJ versus 8% to 26% after open LPJ. Weight gain ranged from 60% to 100% (median: 97, i.q.r.: 23) after minimally invasive LPJ.
This systematic review suggested that minimally invasive LPJ can be performed safely in selected patients with symptomatic chronic pancreatitis. Phase 2 randomized trials should assess potential short-term benefits such as postoperative pain and length of hospital stay after minimally invasive LPJ.
伴有主胰管扩张且胰头大小正常的疼痛性慢性胰腺炎患者，根据指南采用胰管空肠侧侧吻合术（LPJ）进行治疗。本系统评价比较了微创LPJ和开放LPJ的治疗效果。
纳入2000年1月1日至2023年11月13日期间报道的有症状慢性胰腺炎患者微创LPJ和开放LPJ的系列研究。本研究按照PRISMA指南进行构建。主要结局为术中及术后并发症。次要结局包括长期临床结局。
总体纳入19项回顾性研究。微创LPJ术后发病率为0%至57%，开放LPJ术后为4%至68%（中位数：25，四分位间距：23）。微创LPJ术后住院时间为5至7天，开放LPJ术后为6至16天。开放LPJ术后疼痛缓解率为62%至91%（中位数：78.5，四分位间距：23），微创LPJ术后为71%至100%（中位数：82.5，四分位间距：12.5）。微创LPJ新发内分泌功能不全发生率为21%至22%，开放LPJ术后为19%至26%。微创LPJ新发外分泌功能不全发生率为11%至27%，开放LPJ术后为8%至26%。微创LPJ术后体重增加率为60%至100%（中位数：97，四分位间距：23）。
本系统评价提示，对于有症状的慢性胰腺炎患者，可在选定患者中安全地进行微创LPJ。2期随机试验应评估微创LPJ术后潜在的短期获益，如术后疼痛和住院时间。
