【摘要】 目的对比腹腔镜及开腹远端胰腺切除术治疗胰腺导管腺癌(pancreatic ductal adenocarcinoma,PDAC)的疗效及安全性。方法检索2020年10月前公开发表的比较腹腔镜远端胰腺切除术(laparoscopic distal pancreatectomy, LDP)与开腹远端胰腺切除术(open distal pancreatectomy, ODP)治疗PDAC的临床研究。经过筛选,对纳入文献进行质量评价及数据提取,然后使用review manager(RevMan)5.3软件进行统计分析。结果共计15项研究,5 343例患者纳入本研究(LDP组1 396例,ODP组3 947例)。LDP组的术中出血量低[加权均数差(weighted mean difference, WMD)=-112.44,95%置信区间(confidence interval, CI):-193.06～-31.82,P=0.006]、输血率低(OR=0.33,95%CI:0.23～0.49,P<0.000 01)、住院时间短(WMD=-3.35,95%CI:-4.57～-2.13,P<0.000 01)、R0切除率高(OR=1.30,95%CI:1.04～1.64,P=0.02)、3年生存率高(HR=0.84,95%CI:0.76～0.92,P=0.000 4)以及5年生存率高(HR=0.82,95%CI:0.74～0.92,P=0.000 8)。结论治疗胰体尾部PDAC时,LDP相较于ODP在术中出血量、输血率以及住院时间方面更具有优势,同时也有着不弱于ODP的肿瘤学结局。鉴于本研究的局限性,此结果仍需要大样本前瞻性随机对照研究证实。更多还原

【Abstract】 Objective Comparison of the safety and efficacy of laparoscopic and open distal pancreatectomy in the treatment of pancreatic ductal adenocarcinoma.Methods The published clinical studies including laparoscopic distal pancreatectomy(LDP) and open distal pancreatectomy(ODP) in treatment of pancreatic ductal adneocarcinoma(PDAC) before Oct. 2020 were reviewed. After screening, the included literature was subjected to quality evaluation and data extraction, and then, statistical analysis was performed using review manager(RevMan) 5.3 software.Results Fifteen studies with a total of 5 343 patients(1 396 in LDP and 3 947 in ODP) were included for the meta-analysis.LDP showed less blood loss(weighted mean difference, WMD)=-112.44,95%CI(confidence interval, CI):-193.06-31.82,P=0.006),lower blood transfusion rate(OR=0.33,95%CI:0.23-0.49,P<0.000 01),shorter hospitalization time(WMD=-3.35,95%CI:-4.57--2.13,P<0.000 01),higher R0 resection rate(OR=1.30,95%CI:1.04-1.64,P=0.02),higher 3-year overall survival(HR=0.84,95%CI:0.76-0.92,P=0.000 4) and 5-year overall survival(HR=0.82,95%CI:0.74-0.92,P=0.000 8). Conclusions LDP has advantages over ODP in terms of intraoperative bleeding, transfusion rates, and length of stay in the treatment of PDAC in the body and tail of the pancreas, and also has oncologic outcomes that are not inferior to those of ODP.Given the limitations of this study, this result still needs to be confirmed in a large prospective randomized controlled study.更多还原