Clinical efficacy of central pancreatectomy and distal pancreatectomy: a Meta-analysis of the reserved endocrine and exocrine functions of the pancreas

doi:10.3969/j.issn.2095-4344.2015.02.030

Abstract

Abstract:

BACKGROUND: Central pancreatectomy is a surgical treatment for tumors at the neck or the middle part of the pancreas, which can reserve more normal pancreas, not cut adjacent organs, and reduce the incidence of postoperative internal and external pancreatic secretion deficiency with respect to the expanded proximal and distal pancreatectomy.
OBJECTIVE: To systematically evaluate the clinical efficacy of the central pancreatectomy and distal pancreatectomy.
METHODS: A computer-based search of Chinese and English databases was performed, and then 15 controlled clinical trials were included and systematically evaluated using RevMa5.2 software.
RESULTS AND CONCLUSION: Totally 1 079 cases were included in this study, which consisted of 436 central pancreatectomy cases and 643 distal pancreatectomy cases. Meta-analysis showed that compared with the distal pancreatectomy group, the incidences of postoperative pancreatic fistula and complications were significantly higher, the risk of postoperative endocrine and exocrine insufficiency were significantly lower, while the surgical time (SMD: 59.23, 95% CI: 22.41-96.05, P < 0.01) and hospital stays (SMD: 7.01, 95% CI: 1.94-12.09, P < 0.01) were longer in the central pancreatectomy group. These findings indicate that although the central pancreatectomy has a high postoperative complication incidence, it can be accepted clinically, which may be a reasonable operation method to preserve pancreatic exocrine and endocrine function.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: Pancreas, Pancreatectomy, Exocrine Pancreatic Insufficiency, Pancreatic Fistula

CLC Number:

R318

Cao Xing-hua, He Tie-ying, Lin Hai, Han Wei, Chen Qi-long. Clinical efficacy of central pancreatectomy and distal pancreatectomy: a Meta-analysis of the reserved endocrine and exocrine functions of the pancreas[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(2): 322-328.

Figures/Tables 4

2.1 文献检索结果和评价检索文献2 992篇，通过阅读文题、摘要、排除重复发表的文献，选出149篇进一步阅读全文。根据本研究设定的纳入与排除标准，最终纳入15篇文献，所有文献均为英文文献，未检索到符合要求的中文文献，所有文献均检索到全文。纳入患者1 079例研究对象，其中胰腺中段切除组：436例，胰体尾切除组：643例。其中14篇病例回顾性研究，1篇前瞻性研究。纳入文献基本特征见表1，2。 2.2 文献评价非随机性研究的质量评估使用Newcastle- Ottawa Scale (NOS)文献质量评价量表[16]，被检查3项：评估患者选择、胰腺中段切除和胰体尾切除组暴露、和评估的可比性的结果。这种规模的变化从0-9：研究得分等于或高于6认为文献质量较高。 2.3 Meta分析结果 2.3.1 术后胰瘘 15篇文献比较两组术后胰瘘发生率[1-15]，胰腺中段切除和胰体尾切除为38.3%(167/436)和24.4%(157/643)，各研究间同质 (Ⅰ2=31%，P=0.13)，采用固定模型进行合并分析。Meta分析结果显示两组术后胰瘘率差异有显著性意义[OR：2.0，95%CI：1.48-2.71，P < 0.01]。见图1。 2.3.2 术后并发症 12篇文献比较两组术后并发症率[2-13]，胰腺中段切除组与胰体尾切除组并发症率分别为45.7%(164/359)和31.7%(152/480)，各研究间同质(Ⅰ2=38%，P=0.09)，采用固定模型进行合并分析。Meta分析结果显示两组术后并发症率差异有显著性意义[OR：1.52，95%CI:1.11-2.08，P < 0.05]。见图2。 2.3.3 术后出血 8篇文献比较两组术后出血率[2,6,7,9-11,13,15]，胰腺中段切除组与胰体尾切除组出血率分别为4.6%(15/329)和2%(7/335)，各研究间同质(Ⅰ2=32%，P=0.1818)，采用固定模型进行合并分析。Meta分析结果显示两组术后出血率差异无显著性意义[OR：1.52，95%CI：0.91-4.69，P > 0.05]。 2.3.4 术后输血 9篇文献比较两组术后输血率[2, 3, 7-11, 13, 15]，胰腺中段切除组与胰体尾切除组输血率分别为7.2%(24/334)和11.4%(38/334)，各研究间同质(Ⅰ，P=0.64)，采用固定模型进行合并分析。Meta分析结果显示两组术后输血率差异有显著性意义[OR：0.54，95%CI：2=0%"

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