A Meta-analysis Of Duodenum-preserving Pancreatic Head Resection And Pancreatoduodenectomy For Surgical Treatment Of Chronic Pancreatitis

Objective:Through the Meta analysis, evaluate the safety and effectiveness of the pancreaticoduodenectomy(PD) or pylorus-preserving pancreatoduodenectomy(PPPD) and duodenum-preserving pancreatic head resection(DPPHR)for surgical treatment of the chronic pancreatitis.Methods:Retrieve the randomized controlled trial(RCT) about applying PPPD/PD and DPPHR to cure the chronic pancreatitis on Pubmed, EMbase, Springer-Link and the Cochrane library system. According to Cochrane Handbook 5.1, it carries out bias risk evaluation on the incorporated literature. Rev Man 5.3 is selected as the statistics software for processing and analyzing the data of both surgical methods, such as peri-operative mortality, post-operative pain, pancreatic endocrine and exocrine secretion dysfunction inside the pancreas after operation, the whole life quality, etc.Results:Set 7 RCTs and incorporate 366 patients into the analysis. Through the com-parison between PPPD/PD group and DPPHR group, it turns out that the difference on the post-operative odynolysis(RR=0.92, P=0.26), peri-operative mortality(RR=0.75, P=0.45), post-operative emerging pancreatic endocrine dysfunction(RR=1.30, P=0.15), post-operative emerging pancreatic exocrine dysfunction(RR=2.43, P=0.10), postoperative complication occurrence status(RR=1.70, P=0.13) does not have statistical significance; however, the difference on the postoperative recovery(RR=0.72, P=0.008), whole life quality(WMD=-12.06, P<0.01), weight gain(WMD=-4.16, P<0.01) and operation time(WMD=101.53, P<0.01) has statistical significance, and it presents that DPPHR group is superior to PPPD/PD group.Conclusions:Both DPPHR and PPPD/PD are safe and effective in the aspects of peri-operative mortality, post-operative pain relief, post-operative emerging pancreatic endocrine and exocrine secretion dysfunction, post-operative complications. However, DPPHR has more advantages on the operation time, post-operative weight gaining, post-operative recovery than PPPD/PD. It can improve the whole life quality of the patients.