壶腹癌的临床特点分析及Tis-T2期壶腹癌术式选择的Meta分析
发布时间：2019-05-22 02:05
【摘要】：[目的]1、总结分析壶腹癌的临床表现、影像学表现及病理表现;2、探讨外科治疗后影响壶腹癌预后的影响因素;3、应用Meta分析方法,对Tis-T2期壶腹癌行胰十二指肠切除术(Pancreaticoduodenectomy,PD)和局部切除术(Local resection,LR)的治疗疗效进行评价,从循证医学角度为局部切除治疗壶腹癌提供统计学依据。[方法]1.回顾性分析山东省立医院2005年至2016年接受外科手术治疗,病理明确为壶腹癌患者的临床及病历资料。采用Kaplan-Meier法对生存资料进行分析,并做Log-rank检验进行统计学比较。2.检索 Pubmed、EMBASE、Cochrane library、知网等数据库,搜集关于 Tis-T2期壶腹癌行PD与LR治疗对比的相关文献,截止日期到2016年5月。按照Cochrane系统评价方法对文献数据进行数据提取,并按NOS(Newcastle-Ottawa Scale)量表对各纳入文献进行质量评价。采用Cochrane协作网推荐的Revman5.1软件合并统计量及异质性检验。[结果]1、96例壶腹癌患者1、3、5年生存率为82.9%,57.2%,29.6%。术前B超和CT是最常用的检查方式,CT较B超有更高的肿瘤检出率。术前内镜下活检准确率为73.3%。肿瘤直径与肿瘤侵犯深度有明显统计学关系(p0.05),单因素分析肿瘤T分期(p=0.042)、肿瘤大小(P=0.035)、原发肿瘤淋巴结转移(p=0.000)是影响预后的相关因素。淋巴结转移为影响壶腹癌患者生存的独立危险因素2、Meta分析比较Tis-T2期壶腹癌患者PD与LR两种手术方式疗效,共纳入11个研究,在各手术并发症方面,LR均要优于PD。两种术式术后肿瘤复发率(P=0.31,OR=1.42,95%CI(0.73,2.77))及 5 年生存率(P=0.62,OR=0.89,95%CI(0.57,1.39))均无统计学差异。[结论]1、肿瘤直径与肿瘤侵犯深度有明显统计学关系(p0.05),通过肿瘤直径术前、术中的判断,可预估肿瘤的侵犯深度。2、肿瘤侵犯深度、肿瘤大小、原发肿瘤淋巴结转移是影响肿瘤预后的相关因素。淋巴结转移为影响壶腹癌患者生存的独立危险因素。3、Meta分析结果示,对于Tis-T2期壶腹癌的治疗,LR术后并发症发生率明显低于PD;两种手术方式术后肿瘤复发率及5年生存率无统计学差异。4、对于Tis-T2期患者,LR相对于PD,术后并发症少,且不影响预后,是一种可行的手术方式。5、符合以下两条指征的壶腹癌患者在征得患者同意后,可以考虑行壶腹癌局部切除治疗:①临床分期为Tis-T2期,且肿瘤直径2cm,病理分化好;②术前术中检查无明显淋巴结转移。
[Abstract]:[objective] 1. To summarize and analyze the clinical, imaging and pathological features of ampullary carcinoma. 2. To explore the influencing factors of prognosis of ampullary carcinoma after surgical treatment. 3. Meta analysis was used to evaluate the efficacy of pancreatitis (Pancreaticoduodenectomy,PD) and local resection (Local resection,LR) in the treatment of ampullary carcinoma in Tis-T2 stage. From the point of view of evidence-based medicine, it provides statistical basis for local resection in the treatment of ampullary carcinoma. [method] 1. The clinical and medical data of patients with ampullary cancer from 2005 to 2016 in Shandong Provincial Hospital were analyzed retrospectively. the clinical and medical data of patients with ampullary carcinoma were confirmed by pathology. Kaplan-Meier method was used to analyze the survival data, and Log-rank test was used for statistical comparison. 2. The Pubmed,EMBASE,Cochrane library, knowledge network and other databases were searched to collect the literature on the comparison of PD and LR treatment for Tis-T2 stage ampullary cancer. The deadline is from May 2016. According to the Cochrane system evaluation method, the literature data were extracted, and the quality of each included literature was evaluated according to the NOS (Newcastle-Ottawa Scale) scale. The Revman5.1 software proposed by Cochrane Cooperative Network is used to merge statistics and heterogeneity test. [results] 1, the 3-year and 5-year survival rates of 96 patients with ampullary cancer were 82.9%, 57.2% and 29.6%, respectively. Preoperative B-ultrasound and CT are the most commonly used methods. CT has a higher tumor detection rate than B-ultrasound. The accuracy of endoscopic biopsies before operation was 73.3%. There was a significant statistical relationship between tumor diameter and tumor invasion depth (p0.05). Univariate analysis of tumor T stage (p 鈮，
本文编号：2482584
[Abstract]:[objective] 1. To summarize and analyze the clinical, imaging and pathological features of ampullary carcinoma. 2. To explore the influencing factors of prognosis of ampullary carcinoma after surgical treatment. 3. Meta analysis was used to evaluate the efficacy of pancreatitis (Pancreaticoduodenectomy,PD) and local resection (Local resection,LR) in the treatment of ampullary carcinoma in Tis-T2 stage. From the point of view of evidence-based medicine, it provides statistical basis for local resection in the treatment of ampullary carcinoma. [method] 1. The clinical and medical data of patients with ampullary cancer from 2005 to 2016 in Shandong Provincial Hospital were analyzed retrospectively. the clinical and medical data of patients with ampullary carcinoma were confirmed by pathology. Kaplan-Meier method was used to analyze the survival data, and Log-rank test was used for statistical comparison. 2. The Pubmed,EMBASE,Cochrane library, knowledge network and other databases were searched to collect the literature on the comparison of PD and LR treatment for Tis-T2 stage ampullary cancer. The deadline is from May 2016. According to the Cochrane system evaluation method, the literature data were extracted, and the quality of each included literature was evaluated according to the NOS (Newcastle-Ottawa Scale) scale. The Revman5.1 software proposed by Cochrane Cooperative Network is used to merge statistics and heterogeneity test. [results] 1, the 3-year and 5-year survival rates of 96 patients with ampullary cancer were 82.9%, 57.2% and 29.6%, respectively. Preoperative B-ultrasound and CT are the most commonly used methods. CT has a higher tumor detection rate than B-ultrasound. The accuracy of endoscopic biopsies before operation was 73.3%. There was a significant statistical relationship between tumor diameter and tumor invasion depth (p0.05). Univariate analysis of tumor T stage (p 鈮，
本文编号：2482584
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