目的

采用系统评价方法探讨海德堡三角清扫在胰腺癌外科治疗中的意义和临床应用价值。

方法

于2024年4月使用PubMed、Web of Science、Elsevier Journals、中国知网、维普、万方数据库进行计算机检索。英文数据库的检索式为：（“pancreatic cancer” OR “pancreatic neoplasm”） AND（“triangle “ OR “Heidelberg technique” OR “Heidelberg triangle”）；中文数据库的检索式为：（胰腺癌OR胰腺肿瘤AND三角）。检索结果仅限于人类研究和中、英文论文。两位作者独立审查，选择文献。根据纽卡斯尔-渥太华量表（NOS）对文献质量评分。

结果

共检索2 152篇文献，最终4项回顾性队列研究纳入系统综述，文献NOS评分范围为6～8分。525例纳入研究，其中胰十二指肠切除术（PD）队列共327例，全胰切除术（TP）队列共114例，腹腔镜胰十二指肠切除术（LPD）84例。PD队列中海德堡组手术时间（556±46）min，明显长于标准组的（501±61）min（t=3.62，P＜0.05）；术后中位生存时间21个月，明显长于标准组的15个月（χ²=4.30，P＜0.05）；术后3年肿瘤复发率为55.56%，明显低于标准组的83.33%（P=0.040）。TP队列中海德堡组手术时间为434（385，490）min，明显长于标准组的367（315，445）min（P=0.0002）；术中出血量为1 650（1 150，2 550）ml，明显多于标准组的800（500，1 500）ml（P＜0.0001）；R0切除率为30.8%，明显高于标准组的10.5%（P=0.0475）。LPD队列中海德堡组清扫淋巴结数目（11.31±2.46）枚，明显多于标准组的（9.49±2.28）枚（t=3.51，P＜0.05）；R0切除率为76.92%，明显高于标准组的53.33%（χ²=5.06，P=0.024）。

结论

海德堡三角清扫应用于胰腺癌外科治疗是安全可行的，可有效降低术后肿瘤复发率，延长患者生存时间。

Objective

To evaluate the significance and clinical application of Heidelberg triangle dissection in surgical treatment of pancreatic cancer by systematic review.

Methods

In April 2024， literature review was conducted from PubMed， Web of Science， Elsevier Journals， CNKI， Chongqing VIP and Wanfang databases using the key words: （“pancreatic cancer” OR “pancreatic neoplasm”） AND（“triangle” OR “Heidelberg technique” OR “Heidelberg triangle”） in English databases， and the key words:“ pancreatic cancer” OR “pancreatic neoplasm” AND “triangle”） in Chinese databases. The search results were limited to human research and articles in Chinese and English. Two authors independently reviewed and screened the literature. The quality of literatures was assessed by the Newcastle-Ottawa Scale （NOS）.

Results

2 152 studies were retrieved， and 4 retrospective cohort studies were finally included in the systematic review. The NOS scores of the included studies were ranged from 6 to 8. 525 patients were included in this study， including 327 cases of pancreaticoduodenectomy （PD） cohorts， 114 cases of total pancreatectomy （TP） cohorts and 84 cases of laparoscopic pancreaticoduodenectomy （LPD）. In the PD cohorts，the operation time in the Heidelberg tringle dissection group was （556±46） min， significantly longer than（501±61） min in the standard group （t=3.62， P＜0.05）. The median survival time after surgery was 21 months，significantly longer than 15 months in the standard group （χ²=4.30， P＜0.05）. The 3-year tumor recurrence rate was 55.56%， significantly lower than 83.33% in the standard group （P=0.040）. In the TP cohorts， the operation time in the Heidelberg tringle dissection group was 434（385，490） min， significantly longer than 367（315，445） min in the standard group （P=0.0002）. Intraoperative blood loss was 1 650（1 150，2 550） ml，significantly more than 800（500，1500） ml in the standard group （P＜0.0001）. The R0 resection rate was 30.8%， significantly higher than 10.5% in the standard group （P=0.0475）. In the LPD cohorts， the number of dissected lymph nodes in the Heidelberg tringle dissection group was 11.31±2.46， significantly more than 9.49±2.28 in the standard group （t=3.51， P＜0.05）. The R0 resection rate was 76.92%， significantly higher than 53.33% in the standard group （χ²=5.06， P=0.024）.

Conclusions

Heidelberg triangle dissection is safe and feasible in the surgical resection of pancreatic cancer， which can effectively reduce postoperative tumor recurrence rate and prolong the survival time of patients.