通过meta分析综合评价胰腺癌联合动脉切除手术效果

发布时间：2018-06-15 20:01

  本文选题：胰腺癌 + 胰腺癌根治术　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的:通过meta分析对于胰腺癌联合动脉切除手术效果进行综合评价。方法:检索PubMed数据库、Cochrane Library和Web of Science等英文数据库和万方数据库、维普数据库、中国知网数据库等中文数据库。对于2010年至今的胰腺癌联合动脉切除手术的随机对照试验进行收集并且整理,并对其方法进行评价。采用RevMan5.0软件对于收集整理的资料进行综合分析,利用meta分析方法对于联合动脉切除手术组和对照组的手术后并发症、围手术期死亡率、手术后1年生存率、2年生存率和5年生存率进行对比分析。结果:收集来自于中国、美国、德国、法国和日本的12篇论文,研究自1991年至2014年间的1197例患者,其中联合动脉切除组共265人,单纯的胰腺切除或其他手术病人868人,联合静脉切除病人97人未实施手术的64人。手术选择上以患者实际病情为准。实施手术以病人实际病情为分组标准,不遵循随机分组。以联合动脉切除组为处理组,非联合动脉切除组(包括单纯胰腺切除,联合静脉切除,不切除或姑息治疗)为对照组,采用meta分析方法比较手术治疗的效果。结果表明:(1)联合动脉切除手术的患者并发症为54.2%,显著高于单纯胰腺切除对照组(29.4%),也显著高于静脉切除处理;(2)胰腺癌联合动脉切除组的平均手术时间为321.1 min,手术时间长于单纯胰腺切除组(297.5 min),也长于联合静脉切除组(289.2min);(3)胰腺癌联合动脉切除组平均失血量为983.1 ml远大于单纯胰腺切除组和联合静脉切除组的493.7 ml和544.3 ml;(4)在住院时间上,不手术或者行姑息治疗组住院时间最短(加权平均值为17.0 d)。行胰腺癌联合动脉切除组患者住院时间(34.3 d)远高于行单纯胰腺切除组(18.6 d),同时也高于联合静脉切除组(20.8 d);(5)动脉切除组中位生存期加权平均值为14.9个月,小于单纯胰腺切除组(17.5个月),和静脉切除组持平(15.0个月)优于姑息治疗(8.4个月);(6)联合动脉切除组围手术期死亡率为5.2%(5/96),高于单纯胰腺切除组的围手术期死亡率2.6%(20/768),差异有统计学意义(OR=3.16;95%CI=1.14-8.74;Z=2.22);(7)联合动脉切除组的1年生存率为58.3%,略低于单纯胰腺切除组组(59.4%),两者差异未达统计学显著水平(OR=0.66,95%CI=0.41～1.06);而动脉切除组与不切除组比较,不切除组1年生存率为26.6%(17/64)差异具有统计学意义(OR=2.60;95%CI=1.15-5.89;Z=2.29)(8)联合动脉切除处理的2年的生存率为34.5%,略高于非联合动脉切除对照组(31.82%),两者差异未达统计学显著水平(OR=0.83,95%CI=0.44～1.57);(9)联合动脉切除处理的3年的生存率为11.9%,非联合动脉切除对照组为27.0%),两者差异达统计学显著水平(OR=0.36,95%CI=0.16～0.77):(10)仅有一篇文献提供5年生存率资料,结果表明联合动脉切除处理的5年的生存率为0%,而对照组的5年生存率仍有25.9%。结论:胰腺癌联合动脉切除在术后并发症、围手术期死亡率上显著高于单纯的胰腺切除手术,且1年和2年的生存率与单纯的胰腺切除手术无显著差异,但1年生存率及中位生存时间显著高于不手术组。而3年的生存率显著低于单纯的胰腺切除手术。因此,虽然与Mollberg等(2011)分析结果相比,胰腺癌联合动脉切除在1年生存率和2年生存率上提高,但因其居高不下的并发症和围手术期死亡率,以及其较低的长期生存期收益,仍不应作为常规手术选择。
[Abstract]:Objective: To evaluate the effect of pancreatic cancer combined with arterial resection by meta analysis. Methods: retrieval of PubMed database, Cochrane Library, Web of Science and other English databases, Wanfang database, VP database, Chinese knowledge network database, and so on. The operation of pancreatic cancer combined with arterial resection from 2010 to now The randomized controlled trials were collected and evaluated, and their methods were evaluated. The RevMan5.0 software was used to analyze the collected data, and the postoperative complications, the peri operative mortality rate, the 1 year survival rate, the 2 year survival rate, and the 5 year life of the combined artery excision group and the control group were analyzed with the meta analysis. Results: 12 papers from China, the United States, Germany, France and Japan were collected from 1197 patients from 1991 to 2014, including 265 patients in the combined artery resection group, 868 patients with simple pancreatectomy or other surgery, and 64 of the 97 patients who had not been operated on. According to the actual condition of the patient, the operation was performed on the actual condition of the patient, and the patients were divided into groups. The combined arterectomy group was treated as the treatment group, and the non combined artery excision group (including simple pancreatectomy, combined vein resection, no resection or palliative treatment) was used as the control group, and the results of the operation were compared with the results of meta analysis. The results were as follows: (1) the complication of combined arteria resection was 54.2%, significantly higher than that of the simple pancreatectomy control group (29.4%), and significantly higher than that of the venous resection. (2) the average operation time of the combined pancreatectomy group was 321.1 min, the operation time was longer than that of the simple pancreatectomy group (297.5 min), and the operation time was longer than that of the joint venous resection group (289.2min (3) the average blood loss of the combined pancreatectomy group was 983.1 ml far greater than that of the simple pancreatectomy group and the combined venous resection group, 493.7 ml and 544.3 ml; (4) the shortest hospitalization time (weighted mean value was 17 d) in the hospitalization time (weighted mean value was 17 d). The hospitalization time of the combined pancreatectomy group was (34.3 d). It was far higher than the simple pancreatectomy group (18.6 d), but also higher than the combined venous resection group (20.8 d); (5) the median survival time of the arterial resection group was 14.9 months, less than the simple pancreatectomy group (17.5 months), and the venous resection group was (15 months) superior to the palliative treatment (8.4 months); (6) the perioperative death of the combined arterectomy group was (6). The rate of 5.2% (5/96) was 2.6% (20/768) higher than that of the simple pancreatectomy group. The difference was statistically significant (OR=3.16; 95%CI=1.14-8.74; Z=2.22); (7) the 1 year survival rate of the combined artery resection group was 58.3%, slightly lower than that in the simple pancreatectomy group (59.4%), and the difference was not statistically significant (OR=0.66,95%CI=0.41 to 1.06). Compared with the non excision group, the 1 year survival rate of the non excised group was 26.6% (17/64), and the difference was statistically significant (OR=2.60; 95%CI=1.15-5.89; Z=2.29) (8) the 2 year survival rate of the combined artery resection was 34.5%, slightly higher than that in the non combined artery resection control group (31.82%), and the difference was not statistically significant (OR=0.83,95%CI=0.44 To 1.57); (9) the 3 year survival rate of the combined artery excision treatment was 11.9% and the non combined artery excision control group was 27%. The difference was statistically significant (OR=0.36,95%CI=0.16 ~ 0.77): (10) only one literature provided 5 year survival data, and the results showed that the survival rate of the combined artery resection for 5 years was 0%, while the control group had a 5 year of birth. The survival rate still has 25.9%. conclusion: pancreatic cancer combined with arterial resection is significantly higher in perioperative mortality than simple pancreatectomy, and the 1 and 2 year survival rates are not significantly different from simple pancreatectomy, but the 1 year survival rate and median survival time are significantly higher than those in the non operation group. The 3 year survival rate is significantly lower than that of the non operation group. Therefore, although compared with the results of Mollberg (2011) analysis, combined with the 1 year survival rate and the 2 year survival rate, the combination of pancreatic cancer and the 2 year survival rate can not be used as a routine surgical option because of its high complications and peri operative mortality, as well as its lower long-term survival.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.9
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本文编号：2023401