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

doi:10.3877/cma.j.issn.2095-3232.2019.03.007

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。

关键词: 胰腺肿瘤, 腹腔镜, 胰腺切除术, Meta分析, Kimura, Warshaw

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.

Key words: Pancreatic neoplasms, Laparoscopes, Pancreatectomy, Meta-analysis, Kimura, Warshaw

表1 纳入文献基本特征

作者	发表年份	国家	样本量（例）		平均年龄（岁）		性别（男/女）		NOS评分
作者	发表年份	国家	Kimura	Warshaw	Kimura	Warshaw	Kimura	Warshaw	NOS评分
Beane等^[10]	2011	美国	45	41	53.4	56.7	10/350	19/22	8
Butturini等^[11]	2012	意大利	36	7	47±18	44±17	7/29	1/6	7
Hwang等^[12]	2013	韩国	17	4	44±15	37±10	7/10	0/4	8
Jean-Philippe等^[13]	2013	西班牙	55	85	-	-	-	-	7
Lv等^[14]	2013	中国	12	8	38±20	43±16	2/10	3/5	8
Worhunsky等^[15]	2014	美国	19	31	56±11	54±15	10/900	24/70	8
Matsushima等^[16]	2014	日本	7	17	70(50～86)	49(30～83)	4/30	03/14	7
Zhou等^[17]	2014	中国	206	40	50±14	49±12	63/143	05/35	6
胡文迪^[18]	2014	中国	28	17	42±13	39±15	4/24	04/13	7
Lee等^[19]	2016	韩国	63	26	52(16～78)	51(20～78)	24/390	05/21	8
杨洲^[20]	2016	中国	15	5	-	-	-	-	6
Nakamura等^[21]	2016	日本	11	6	43±23	59±18	5/60	4/2	8

表1 纳入文献基本特征

作者	发表年份	国家	样本量（例）		平均年龄（岁）		性别（男/女）		NOS评分
作者	发表年份	国家	Kimura	Warshaw	Kimura	Warshaw	Kimura	Warshaw	NOS评分
Beane等^[10]	2011	美国	45	41	53.4	56.7	10/350	19/22	8
Butturini等^[11]	2012	意大利	36	7	47±18	44±17	7/29	1/6	7
Hwang等^[12]	2013	韩国	17	4	44±15	37±10	7/10	0/4	8
Jean-Philippe等^[13]	2013	西班牙	55	85	-	-	-	-	7
Lv等^[14]	2013	中国	12	8	38±20	43±16	2/10	3/5	8
Worhunsky等^[15]	2014	美国	19	31	56±11	54±15	10/900	24/70	8
Matsushima等^[16]	2014	日本	7	17	70(50～86)	49(30～83)	4/30	03/14	7
Zhou等^[17]	2014	中国	206	40	50±14	49±12	63/143	05/35	6
胡文迪^[18]	2014	中国	28	17	42±13	39±15	4/24	04/13	7
Lee等^[19]	2016	韩国	63	26	52(16～78)	51(20～78)	24/390	05/21	8
杨洲^[20]	2016	中国	15	5	-	-	-	-	6
Nakamura等^[21]	2016	日本	11	6	43±23	59±18	5/60	4/2	8

图1 Kimura法与Warshaw法脾梗死发生率比较Meta分析森林图

[1]	Cuschieri A,Jakimowicz JJ,van Spreeuwel J. Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis[J]. Ann Surg, 1996, 223(3):280-285.
[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 meta-analysis[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 spleen-preserving 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 spleen-preserving 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 spleen-preserving 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 J Surg, 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.

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Comparison of clinical efficacy of laparoscopic spleen-preserving distal pancreatectomy between Kimura technique and Warshaw technique: a Meta-analysis

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Comparison of clinical efficacy of laparoscopic spleen-preserving distal pancreatectomy between Kimura technique and Warshaw technique: a Meta-analysis