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目的:系统性评价腹腔镜下保留脾脏的胰体尾切除术在胰体尾部肿瘤治疗中的临床疗效。方法:检索多个国内外文献数据库,根据纳入排除标准,筛选出符合要求的文献,提取数据并进行文献质量评价,应用RevMan 5.3软件进行Meta分析。结果:共纳入13篇文献,总计814例患者,其中行腹腔镜下保留脾脏的胰体尾切除术399例,行腹腔镜下胰体尾联合脾脏切除术415例。Meta分析结果显示,腹腔镜下保留脾脏的胰体尾切除术患者的手术时间(SMD=-0.79,95%CI=-1.55~-0.03,P=0.04)、术中失血量(SMD=-1.00,95%CI=-1.76~-0.24,P=0.01)及住院时间(SMD=-0.77,95%CI=-1.34~-0.21,P=0.008)均明显少于腹腔镜下胰体尾联合脾脏切除术患者;两组患者术后并发症发生率(OR=0.83,95%CI=0.63~1.10,P=0.19)及再次手术治疗率(OR=1.54,95%CI=0.52~4.59,P=0.44)差异均无统计学意义。结论:腹腔镜下保脾胰体尾切除术治疗胰体尾部肿瘤有较好的临床疗效,不会增加术后并发症发生率。
OBJECTIVE: To systematically evaluate the clinical efficacy of laparoscopic splenic pancreatectomy in the treatment of pancreatic body tail tumors. Methods: A number of domestic and foreign literature databases were searched. According to inclusion exclusion criteria, eligible documents were screened, data were extracted and literature quality evaluated. Meta-analysis was performed using RevMan 5.3 software. Results: A total of 13 articles were enrolled in this study. A total of 814 patients were enrolled. Among them, 399 cases underwent pancreatectomy and resection of the spleen under laparoscopy and 415 cases underwent laparoscopic pancreatectomy combined with splenectomy. The results of Meta analysis showed that the operation time of patients undergoing laparoscopic pancreatectomy (SMD = -0.79, 95% CI = -1.55-0.03, P = 0.04) and intraoperative blood loss (SMD = -1.00 , 95% CI = -1.76 ~ -0.24, P = 0.01) and hospital stay (SMD = -0.77,95% CI = -1.34 ~ -0.21, P = 0.008) were significantly less than the laparoscopic pancreas tail joint spleen (OR = 0.83, 95% CI = 0.63-1.10, P = 0.19) and reoperation rate (OR = 1.54, 95% CI = 0.52-4.59, P = 0.44) difference was not statistically significant. Conclusion: Laparoscopic spleen-conserving pancreatic tail resection for the treatment of pancreatic body tail tumors have better clinical efficacy, does not increase the incidence of postoperative complications.