胰十二指肠切除术中扩大和标准淋巴结清扫对淋巴结阳性胰头癌患者生存期影响的Meta分析

目的 评价扩大和标准淋巴结清扫在行胰十二指肠切除术的淋巴结阳性胰头癌患者远期生存的差异。方法 检索1990年1月-2015年10月间PubMed、Embase、Medline、Cochrane library数据库及中国生物医学文献数据库（CBMDisc），查询相关的临床随机对照试验。使用RevMa5.2软件进行系统评价。结果 共纳入5项研究，6篇文章。扩大胰十二指肠切除术组的淋巴结数明显高于标准胰十二指肠切除术组。淋巴结阳性患者行扩大清扫能提高5年生存率，且差异有统计学意义（RR: 2.27, 95%CI:1.08~4.79, P=0.03）；而1、3年生存率差异无统计学意义。结论 扩大淋巴结清扫的胰十二指肠切除术可能提高淋巴结阳性患者远期生存率。如无明确淋巴结转移证据，不必行扩大淋巴结清扫术。

Meta-analysis of Long-term Survival of Extended and Standard Pancreaticoduodenectomy for Carcinoma of Head of Pancreas with Positive Lymph Nodes

Objective To compare the long-term survival of standard and extended pancreaticoduodenecto my(PD) for the patients with carcinoma of the head of pancreas with positive lymph nodes by Meta-analysis. Methods A literature search of PubMed, Embase, Medline, Cochrane library and CBMDisc from January 1990 to October 2015 was performed. Systems analysis was proceeded by RevMa5.2 software. Results Five RCT studies of six articles were involved. Extended pancreaticoduodenectomy (EPD) acquired more lymph nodes than standard pancreaticoduodenectomy (SPD). For the patients with positive lymph nodes, EPD prolonged the postoperative 5-year survival rate (RR: 2.27, 95％CI: 1.08-4.79, P=0.03), but there was no difference with SPD in 1- and 3-year survival rates. Conclusion EPD may prolong the long-term survival rate of the patients with lymph positive pancreatic head carcinoma. EPD is unnecessary if there is no evidence of lymphatic metastasis.