| Objective:The Meta analysis method was used to systematically evaluate the efficacy of artery first approach for pancreatoduodenectomy and standard pancreatoduodenectomy for the treatment of periampullay tumors.Methods:Computer searches of domestic and foreign databases such as PUBMED,CNKI,and CBM from 2003 to 2018.In strict accordance with the inclusion and exclusion criteria for document screening,and two researchers in accordance with the Cochrane system for literature quality evaluation,using the RevMan5.3 software for meta-analysis of the data,compare artery first approach pancreatoduodenectomy and traditional standards pancreatoduodenectomy into efficacy.Results:In the end,a total of 9 case-control trials meeting the criteria were included.Of the total 736 patients,381 patients received artery first approach.Analysis of the data showed that artery first approach for pancreaticoduodenectomy was superior to standard approach pancreatoduodenectomy on the time of surgery [MD =-24.22;98% CI:(-44.16,-4.27);p = 0.02],intraoperative blood loss [MD =-32.41;98% CI:(-38.95,-25.86);p<0.00001],lymph node dissection number [MD=1.1;98% CI:(0.67,1.52);p<0.00001],R0 resection rate [MD=1.14;98%CI:(1.04,1.25);p=0.007],delay of gastric emptying [MD=0.60;98% CI:(0.4.3.83);p=0.002],and the difference was statisticallysignificant.However,there was no significant difference in intraoperative blood transfusion volume,drainage tube removal time,hospitalization days,total postoperative complication rate,R1 resection rate,pancreatic fistula,abdominal bleeding,and diarrhea.Conclusion:Artery first approach for pancreaticoduodenectomy can improve RO resection rate in the treatment of periampullary tumors and pancreatic cancer.It is also beneficial for lymph node dissection,reducing intraoperative blood loss,shortening operation time,and reducing occur of gastric emptying dysfunction.But,there was no significant difference in the incidence of postoperative complications,pancreatic fistula,and diarrhea. |
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