本文選題：胰腺癌 + 胰腺癌根治術　； 參考：《浙江大學》2017年碩士論文

【摘要】：目的:通過meta分析對于胰腺癌聯合動脈切除手術效果進行綜合評價。方法:檢索PubMed數據庫、Cochrane Library和Web of Science等英文數據庫和萬方數據庫、維普數據庫、中國知網數據庫等中文數據庫。對于2010年至今的胰腺癌聯合動脈切除手術的隨機對照試驗進行收集并且整理,并對其方法進行評價。采用RevMan5.0軟件對于收集整理的資料進行綜合分析,利用meta分析方法對于聯合動脈切除手術組和對照組的手術后并發(fā)癥、圍手術期死亡率、手術后1年生存率、2年生存率和5年生存率進行對比分析。結果:收集來自于中國、美國、德國、法國和日本的12篇論文,研究自1991年至2014年間的1197例患者,其中聯合動脈切除組共265人,單純的胰腺切除或其他手術病人868人,聯合靜脈切除病人97人未實施手術的64人。手術選擇上以患者實際病情為準。實施手術以病人實際病情為分組標準,不遵循隨機分組。以聯合動脈切除組為處理組,非聯合動脈切除組(包括單純胰腺切除,聯合靜脈切除,不切除或姑息治療)為對照組,采用meta分析方法比較手術治療的效果。結果表明:(1)聯合動脈切除手術的患者并發(fā)癥為54.2%,顯著高于單純胰腺切除對照組(29.4%),也顯著高于靜脈切除處理;(2)胰腺癌聯合動脈切除組的平均手術時間為321.1 min,手術時間長于單純胰腺切除組(297.5 min),也長于聯合靜脈切除組(289.2min);(3)胰腺癌聯合動脈切除組平均失血量為983.1 ml遠大于單純胰腺切除組和聯合靜脈切除組的493.7 ml和544.3 ml;(4)在住院時間上,不手術或者行姑息治療組住院時間最短(加權平均值為17.0 d)。行胰腺癌聯合動脈切除組患者住院時間(34.3 d)遠高于行單純胰腺切除組(18.6 d),同時也高于聯合靜脈切除組(20.8 d);(5)動脈切除組中位生存期加權平均值為14.9個月,小于單純胰腺切除組(17.5個月),和靜脈切除組持平(15.0個月)優(yōu)于姑息治療(8.4個月);(6)聯合動脈切除組圍手術期死亡率為5.2%(5/96),高于單純胰腺切除組的圍手術期死亡率2.6%(20/768),差異有統(tǒng)計學意義(OR=3.16;95%CI=1.14-8.74;Z=2.22);(7)聯合動脈切除組的1年生存率為58.3%,略低于單純胰腺切除組組(59.4%),兩者差異未達統(tǒng)計學顯著水平(OR=0.66,95%CI=0.41～1.06);而動脈切除組與不切除組比較,不切除組1年生存率為26.6%(17/64)差異具有統(tǒng)計學意義(OR=2.60;95%CI=1.15-5.89;Z=2.29)(8)聯合動脈切除處理的2年的生存率為34.5%,略高于非聯合動脈切除對照組(31.82%),兩者差異未達統(tǒng)計學顯著水平(OR=0.83,95%CI=0.44～1.57);(9)聯合動脈切除處理的3年的生存率為11.9%,非聯合動脈切除對照組為27.0%),兩者差異達統(tǒng)計學顯著水平(OR=0.36,95%CI=0.16～0.77):(10)僅有一篇文獻提供5年生存率資料,結果表明聯合動脈切除處理的5年的生存率為0%,而對照組的5年生存率仍有25.9%。結論:胰腺癌聯合動脈切除在術后并發(fā)癥、圍手術期死亡率上顯著高于單純的胰腺切除手術,且1年和2年的生存率與單純的胰腺切除手術無顯著差異,但1年生存率及中位生存時間顯著高于不手術組。而3年的生存率顯著低于單純的胰腺切除手術。因此,雖然與Mollberg等(2011)分析結果相比,胰腺癌聯合動脈切除在1年生存率和2年生存率上提高,但因其居高不下的并發(fā)癥和圍手術期死亡率,以及其較低的長期生存期收益,仍不應作為常規(guī)手術選擇。
[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.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.9
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本文編號：2023401