背景:胰腺良性,囊性的,和神经内分泌肿瘤越来越多地被发现并推荐手术治疗。在多器官切除胰十二指肠切除术或保留薄壁组织中,局部摘除对于手术相关术后早期和晚期发病率的决策是一项挑战.
方法:PubMed,Embase,在CochraneLibraries中搜索了报告胰十二指肠切除术(PD)和保留十二指肠的全部(DPPHRt)或部分(DPPHRp)胰头切除术治疗良性肿瘤后早期手术相关并发症的研究.分析了来自1099名患者的34项队列研究。总的来说,654例患者接受DPPHR,445例患者因良性肿瘤接受PD。本综述和荟萃分析不需要伦理批准。
结果:比较DPPHRt和PD,需要输血(OR0.20,95%CI0.10-0.41,p<0.01),严重手术相关并发症的再干预(OR0.48,95%CI0.31-0.73,p<0.001),严重并发症的再次手术(OR0.50,95%CI0.26-0.95,p=0.04)在DPPHRt后明显减少。胰瘘B+C(19.0~15.3%,p=0.99)和胆瘘(6.3至4.3%;p=0.33)在PD和DPPHRt后处于相同范围。DPPHRt后的住院死亡率为350例患者中的1例(0.28%),PD后的445例患者中有8例(1.79%)(OR0.32,95%CI0.10-1.09,p=0.07)。在DPPHRp之后,192例患者中没有死亡.
结论:DPPHR治疗胰腺良性肿瘤与手术相关的较少相关。严肃,与PD相比,严重的术后并发症和更低的院内死亡率。DPPHRt或DPPHRp的定制使用有助于减少手术相关的并发症。DPPHR有可能替代PD治疗胰头良性肿瘤和癌前囊性和神经内分泌肿瘤。
Pancreatic benign, cystic, and neuroendocrine neoplasms are increasingly detected and recommended for surgical treatment. In multiorgan resection pancreatoduodenectomy or parenchyma-sparing, local extirpation is a challenge for decision-making regarding surgery-related early and late postoperative morbidity.
PubMed, Embase, and Cochrane Libraries were searched for studies reporting early surgery-related complications following pancreatoduodenectomy (PD) and duodenum-preserving total (DPPHRt) or partial (DPPHRp) pancreatic head resection for benign tumors. Thirty-four cohort studies comprising data from 1099 patients were analyzed. In total, 654 patients underwent DPPHR and 445 patients PD for benign tumors. This review and meta-analysis does not need ethical approval.
Comparing DPPHRt and PD, the need for blood transfusion (OR 0.20, 95% CI 0.10-0.41, p<0.01), re-intervention for serious surgery-related complications (OR 0.48, 95% CI 0.31-0.73, p<0.001), and re-operation for severe complications (OR 0.50, 95% CI 0.26-0.95, p=0.04) were significantly less frequent following DPPHRt. Pancreatic fistula B+C (19.0 to 15.3%, p=0.99) and biliary fistula (6.3 to 4.3%; p=0.33) were in the same range following PD and DPPHRt. In-hospital mortality after DPPHRt was one of 350 patients (0.28%) and after PD eight of 445 patients (1.79%) (OR 0.32, 95% CI 0.10-1.09, p=0.07). Following DPPHRp, there was no mortality among the 192 patients.
DPPHR for benign pancreatic tumors is associated with significantly fewer surgery-related, serious, and severe postoperative complications and lower in-hospital mortality compared to PD. Tailored use of DPPHRt or DPPHRp contributes to a reduction of surgery-related complications. DPPHR has the potential to replace PD for benign tumors and premalignant cystic and neuroendocrine neoplasms of the pancreatic head.