腹腔镜保脾胰体尾切除术Kimura法和Warshaw法临床疗效对比Meta分析
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摘要
目的比较腹腔镜保脾胰体尾切除术中脾血管保留(Kimura法)和脾血管切除(Warshaw法)的临床疗效。方法检索2018年8月1日以前Pubmed、EMBASE、CNKI和万方数据库的文献。英文检索词包括laparoscopic、pancreatectomy、pancreatic neoplasms、spleen、Kimura、Warshaw;中文检索词包括腹腔镜、胰腺切除、胰腺肿瘤、脾脏、Kimura、Warshaw。对纳入研究的文献提取包括手术时间、术中出血量、总并发症发生率、胰瘘发生率、脾梗死发生率、住院时间数据进行Meta分析。结果共纳入12篇文献共计801例患者,其中Kimura法514例,Warshaw法287例。Meta分析结果显示,Kimura法术后脾梗死发生率较Warshaw法低(OR=0.13,95%CI:0.08～0.23;P<0.05)。Kimura法与Warshaw法在住院时间、术中出血量、手术时间方面差异无统计学意义(SMD=0.31,-0.12,-0.05;P>0.05)。两种方法术后总并发症发生率、胰瘘发生率差异亦无统计学意义(OR=0.65,0.87;P>0.05)。结论 Kimura法术后脾梗死发生率较Warshaw法低,Kimura法在腹腔镜保脾胰体尾切除术中更有优势,可作为首选术式。
Objective To compare the clinical efficacy of laparoscopic spleen-preserving distal pancreatectomy between Kimura technique and Warshaw technique. Methods Literature before August 1, 2018 were reviewed from PubMed, EMBASE, CNKI and Wanfang database by using the keywords laparoscopic, pancreatectomy, pancreatic neoplasms, spleen, Kimura and Warshaw in both English and Chinese. Data about operation time, intraoperative blood loss, total incidence of complications, pancreatic fistula, splenic infarction and length of hospital stay were extracted and subjected to Meta-analysis. Results A total of 801 patients were enrolled from 12 articles, including 514 cases treated with Kimura technique and 287 cases with Warshaw technique. Meta-analysis revealed that the incidence of postoperative splenic infarction of Kimura technique was significantly lower than that of Warshaw technique(OR=0.13, 95%CI:0.08-0.23; P<0.05). No significant difference was observed in the length of hospital stay, intraoperative blood loss and operation time between two techniques(SMD=0.31,-0.12,-0.05; P>0.05). And no significant difference was observed in the total incidence of postoperative complications and incidence of pancreatic fistula between two techniques(OR=0.65, 0.87; P>0.05). Conclusions The incidence of postoperative splenic infarction in patients using Kimura technique is lower compared with those using Warshaw technique.Kimura technique is better than Warshaw technique for laparoscopic spleen-preserving pancreatectomy, which can be the primary choice for operation.
Objective To compare the clinical efficacy of laparoscopic spleen-preserving distal pancreatectomy between Kimura technique and Warshaw technique. Methods Literature before August 1, 2018 were reviewed from PubMed, EMBASE, CNKI and Wanfang database by using the keywords laparoscopic, pancreatectomy, pancreatic neoplasms, spleen, Kimura and Warshaw in both English and Chinese. Data about operation time, intraoperative blood loss, total incidence of complications, pancreatic fistula, splenic infarction and length of hospital stay were extracted and subjected to Meta-analysis. Results A total of 801 patients were enrolled from 12 articles, including 514 cases treated with Kimura technique and 287 cases with Warshaw technique. Meta-analysis revealed that the incidence of postoperative splenic infarction of Kimura technique was significantly lower than that of Warshaw technique(OR=0.13, 95%CI:0.08-0.23; P<0.05). No significant difference was observed in the length of hospital stay, intraoperative blood loss and operation time between two techniques(SMD=0.31,-0.12,-0.05; P>0.05). And no significant difference was observed in the total incidence of postoperative complications and incidence of pancreatic fistula between two techniques(OR=0.65, 0.87; P>0.05). Conclusions The incidence of postoperative splenic infarction in patients using Kimura technique is lower compared with those using Warshaw technique.Kimura technique is better than Warshaw technique for laparoscopic spleen-preserving pancreatectomy, which can be the primary choice for operation.
引文
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[4]Venkat R,Edil BH,Schulick RD,et al.Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique:a systematic review and metaanalysis[J].Ann Surg,2012,255(6):1048-1059.
[5]Van Hilst J,de Rooij T,Klompmaker S,et al.Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma(DIPLOMA):a Pan-European Propensity Score Matched Study[J].Ann Surg,2019,269(1):10-17.
[6]Di Sabatino A,Carsetti R,Corazza GR.Post-splenectomy and hyposplenic states[J].Lancet,2011,378(9785):86-97.
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[8]Kimura W,Inoue T,Futakawa N,et al.Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein[J].Surgery,1996,120(5):885-890.
[9]Warshaw AL.Conservation of the spleen with distal pancreatectomy[J].Arch Surg,1988,123(5):550-553.
[10]Beane JD,Pitt HA,Nakeeb A,et al.Splenic preserving distal pancreatectomy:does vessel preservation matter?[J].J Am Coll Surg,2011,212(4):651-657.
[11]Butturini G,Inama M,Malleo G,et al.Perioperative and long-term results of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessels conservation:a retrospective analysis[J].J Surg Oncol,2012,105(4):387-392.
[12]Hwang HK,Kang CM,Chung YE,et al.Robot-assisted spleenpreserving distal pancreatectomy:a single surgeon's experiences and proposal of clinical application[J].Surg Endosc,2013,27(3):774-781.
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[14]Lv GY,Wang GY,Jiang C,et al.Laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessel conservation:a retrospective study of 20 cases[J].Hepato-gastroenterology,2013,60(127):1785-1788.
[15]Worhunsky DJ,Zak Y,Dua MM,et al.Laparoscopic spleenpreserving distal pancreatectomy:the technique must suit the lesion[J].J Gastrointest Surg,2014,18(8):1445-1451.
[16]Matsushima H,Kuroki T,Adachi T,et al.Laparoscopic spleenpreserving distal pancreatectomy with and without splenic vessel preservation:the role of the Warshaw procedure[J].Pancreatology,2014,14(6):530-535.
[17]Zhou ZQ,Kim SC,Song KB,et al.Laparoscopic spleen-preserving distal pancreatectomy:comparative study of spleen preservation with splenic vessel resection and splenic vessel preservation[J].World JSurg,2014,38(11):2973-2979.
[18]胡文迪.保脾腹腔镜胰体尾切除术脾血管保留与脾血管切除的对比研究[D].杭州:浙江大学,2014.
[19]Lee LS,Hwang HK,Kang CM,et al.Minimally invasive approach for spleen-preserving distal pancreatectomy:a comparative analysis of postoperative complication between splenic vessel conserving and Warshaw's technique[J].J Gastrointest Surg,2016,20(8):1464-1470.
[20]杨洲.腹腔镜保留脾脏的胰腺远端切除术临床疗效研究[D].济南:山东大学,2016.
[21]Nakamura Y,Matsushita A,Mizuguchi Y,et al.Study on laparoscopic spleen preserving distal pancreatectomy procedures comparing splenic vessel preservation and non-preservation[J].Transl Gastroenterol Hepatol,2016(1):27.
[22]Shoup M,Brennan MF,McWhite K,et al.The value of splenic preservation with distal pancreatectomy[J].Arch Surg,2002,137(2):164-168.
[23]Yoon YS,Lee KH,Han HS,et al.Effects of laparoscopic versus open surgery on splenic vessel patency after spleen and splenic vessel-preserving distal pancreatectomy:a retrospective multicenter study[J].Surg Endosc,2015,29(3):583-588.
[24]Louis D,Alassiri A,Kirzin S,et al.Gastric bleeding risk following spleen preserving distal pancreatectomy with excision of the splenic vessels:a long-term follow-up[J].HPB,2017,19(4):345-351.
[2]Bandoh T,Shiraishi N,Yamashita Y,et al.Endoscopic surgery in Japan:the 12th national survey(2012-2013)by the Japan Society for Endoscopic Surgery[J].Asian J Endosc Surg,2017,10(4):345-353.
[3]Nakamura M,Nakashima H.Laparoscopic distal pancreatectomy and pancreatoduodenectomy:is it worthwhile?a meta-analysis of laparoscopic pancreatectomy[J].J Hepatobiliary pancrea Sci,2013,20(4):421-428.
[4]Venkat R,Edil BH,Schulick RD,et al.Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique:a systematic review and metaanalysis[J].Ann Surg,2012,255(6):1048-1059.
[5]Van Hilst J,de Rooij T,Klompmaker S,et al.Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma(DIPLOMA):a Pan-European Propensity Score Matched Study[J].Ann Surg,2019,269(1):10-17.
[6]Di Sabatino A,Carsetti R,Corazza GR.Post-splenectomy and hyposplenic states[J].Lancet,2011,378(9785):86-97.
[7]Mellemkjoer L,Olsen JH,Linet MS,et al.Cancer risk after splenectomy[J].Cancer,1995,75(2):577-583.
[8]Kimura W,Inoue T,Futakawa N,et al.Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein[J].Surgery,1996,120(5):885-890.
[9]Warshaw AL.Conservation of the spleen with distal pancreatectomy[J].Arch Surg,1988,123(5):550-553.
[10]Beane JD,Pitt HA,Nakeeb A,et al.Splenic preserving distal pancreatectomy:does vessel preservation matter?[J].J Am Coll Surg,2011,212(4):651-657.
[11]Butturini G,Inama M,Malleo G,et al.Perioperative and long-term results of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessels conservation:a retrospective analysis[J].J Surg Oncol,2012,105(4):387-392.
[12]Hwang HK,Kang CM,Chung YE,et al.Robot-assisted spleenpreserving distal pancreatectomy:a single surgeon's experiences and proposal of clinical application[J].Surg Endosc,2013,27(3):774-781.
[13]Jean-Philippe A,Alexandre J,Christophe L,et al.Laparoscopic spleen-preserving distal pancreatectomy:splenic vessel preservation compared with the Warshaw technique[J].JAMA Surg,2013,148(3):246-252.
[14]Lv GY,Wang GY,Jiang C,et al.Laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessel conservation:a retrospective study of 20 cases[J].Hepato-gastroenterology,2013,60(127):1785-1788.
[15]Worhunsky DJ,Zak Y,Dua MM,et al.Laparoscopic spleenpreserving distal pancreatectomy:the technique must suit the lesion[J].J Gastrointest Surg,2014,18(8):1445-1451.
[16]Matsushima H,Kuroki T,Adachi T,et al.Laparoscopic spleenpreserving distal pancreatectomy with and without splenic vessel preservation:the role of the Warshaw procedure[J].Pancreatology,2014,14(6):530-535.
[17]Zhou ZQ,Kim SC,Song KB,et al.Laparoscopic spleen-preserving distal pancreatectomy:comparative study of spleen preservation with splenic vessel resection and splenic vessel preservation[J].World JSurg,2014,38(11):2973-2979.
[18]胡文迪.保脾腹腔镜胰体尾切除术脾血管保留与脾血管切除的对比研究[D].杭州:浙江大学,2014.
[19]Lee LS,Hwang HK,Kang CM,et al.Minimally invasive approach for spleen-preserving distal pancreatectomy:a comparative analysis of postoperative complication between splenic vessel conserving and Warshaw's technique[J].J Gastrointest Surg,2016,20(8):1464-1470.
[20]杨洲.腹腔镜保留脾脏的胰腺远端切除术临床疗效研究[D].济南:山东大学,2016.
[21]Nakamura Y,Matsushita A,Mizuguchi Y,et al.Study on laparoscopic spleen preserving distal pancreatectomy procedures comparing splenic vessel preservation and non-preservation[J].Transl Gastroenterol Hepatol,2016(1):27.
[22]Shoup M,Brennan MF,McWhite K,et al.The value of splenic preservation with distal pancreatectomy[J].Arch Surg,2002,137(2):164-168.
[23]Yoon YS,Lee KH,Han HS,et al.Effects of laparoscopic versus open surgery on splenic vessel patency after spleen and splenic vessel-preserving distal pancreatectomy:a retrospective multicenter study[J].Surg Endosc,2015,29(3):583-588.
[24]Louis D,Alassiri A,Kirzin S,et al.Gastric bleeding risk following spleen preserving distal pancreatectomy with excision of the splenic vessels:a long-term follow-up[J].HPB,2017,19(4):345-351.