解剖性和非解剖性切除治疗小肝细胞癌疗效的Meta分析

Anatomic resection vs nonanatomic resection for treatment of small hepatocellular carcinoma: a metaanalysis

目的比较解剖性切除和非解剖性切除治疗小肝癌疗效的差异。方法计算机检索PubMed、Medline、中国期刊全文数据库(CJFD)及万方数据库1980-2010年发表的有关解剖性切除和非解剖性切除治疗小肝癌的相关文献,采用RevMan5.0进行Meta分析。结果按照入选标准,有6项临床试验纳入。Meta分析结果显示,与非解剖性切除相比,解剖性切除能明显增加3年总存活率[OR=1.17,95%CI(1.11,2.83),P=0.02]及5年总存活率[OR=1.61,95%CI(1.16,2.25),P=0.005],1年无瘤存活率[OR=1.65,95%CI(1.01,2.68),P=0.04]、3年无瘤存活率[OR=1.74,95%CI(1.13,2.68),P=0.01]及5年无瘤存活率[OR=2.22,95%CI(1.61,3.06),P<0.01],也能降低术后复发率[OR=0.55,95%CI(0.37,0.81),P=0.003]。但术后死亡率(P=0.90)和术后并发症发生率(P=0.37)差异无统计学意义。结论对肝储备功能良好的患者,当肿瘤适宜于行解剖性肝段切除治疗时应首选解剖性切除;对肝储备功能较差的患者,则应行非解剖性切除,避免术后发生肝功能衰竭。

Objective To systematically evaluate the difference between the therapeutic effects of anatomic resection（AR） and nonanatomic resection（NAR） for small hepatocellular carcinoma.Methods The literature about the therapeutic effect of AR and NAR on small hepatocellular carcinoma were collected from PubMed,Medline,Chinese Journal Full-text Database（CJFD） and Wanfang database from 1980 to 2010.RevMan5.0 software was used for data analysis.Results According to the included criteria,6 clinical trials were selected finally.The results of meta-analysis showed that there was significant difference in overall survival between the two groups at 3 years [OR=1.17,95%CI（1.11,2.83）,P=0.02] and 5 years [OR=1.61,95%CI（1.16,2.25）,P=0.005],and in disease-free survival at 1 year [OR=1.65,95%CI（1.01,2.68）,P=0.04],3 years [OR=1.74,95%CI（1.13,2.68）,P=0.01] and 5 years [OR=2.22,95%CI（1.61,3.06）,P0.01],and postoperative recurrence between the two groups were also similar [OR=0.55,95%CI（0.37,0.81）,P=0.003].The rate of postoperative mortality and postoperative morbidity had no significant difference between the two groups.Conclusion When the tumor should be suitable for anatomical liver resection,anatomic resection should be the first choice for the patients with well-preserved liver function,but for these patients who have poor liver functional reserve,nonanatomic resection should be the line to avoid postoperative liver failure.