腹腔镜与开腹行左半肝切除治疗原发性肝癌近期疗效及安全性的系统评价

Short-Term Effectiveness and Safety of Laparoscopic versus Open Left Hepatectomy for Primary Cancer: A Systematic Review

目的系统评价腹腔镜与开腹行左半肝切除的近期疗效及安全性。方法计算机检索CENTRAL(2012年第1期)、MEDLINE/PubMed(1978～2012)、EMbase(1966～2012)、CBM(1978～2012)、CNKI(1979～2012)和中华医学会数字化期刊系统(1990～2012),收集比较腹腔镜与开腹行左半肝切除的临床试验,并手检相关会议论文及追溯纳入文献的参考文献。由2位评价者根据纳入标准筛选文献、提取资料并评价质量后,采用RevMan5.0版软件进行Meta分析。结果未获得随机对照试验,最终仅纳入5个临床同期对照试验,共319例患者。Meta分析结果显示:腹腔镜组手术时间长于开腹切除组[WMD=40.89,95%CI(29.39,55.38),P<0.000 01],术中出血量少于开腹切除组[WMD=–107.84,95%CI(–208.96,–6.73),P=0.04],而术后住院天数[WMD=–3.78,95%CI(–9.60,2.04),P=0.20]及术后并发症[WMD=0.69,95%CI(0.37,1.29),P=0.25]方面差异均无统计学意义。结论腹腔镜左半肝切除术作为一种微创技术,与开腹左半肝切除术相比,具有腹壁切口较小、术中出血量较少等优点,利于提高患者的生活质量。受纳入研究的数量和质量所限,尚不能判断偏倚对结论可靠性的影响程度。建议今后开展更多高质量大样本多中心且随访时间足够的相关研究以获取更可靠的证据。

Objective To evaluate the short-term effectiveness and safety oflaparoscopic versus conventional open left hepatectomy. Methods Databases including CENTRAL （Issue 1, 2012）, MEDLINE/PubMed （1978 to 2012）, EMbase （1966 to 2012）, CBM （1978 to 2012）, CNKI （1979 to 2012） and the Chinese Medical Association Figures Journal Systems （1990 to 2012） were searched to collect clinical trials on laparoscopic versus conventional open left hepatectomy. Relevant proceedings and references of the included studies were also retrieved manually. According to the inclusion criteria, two reviewers independently screened literature, extracted data and assessed quality. Then meta-analysis was conducted using RevMan5.0 software. Results No randomized controlled trials were collected, and a total of 5 clinical concurrent controlled trials involving 319 patients were included finally. The results of meta-analysis showed that, compared with the conventional open group, the laparoscopic group was longer in the operation time （WMD=40.89, 95%CI 29.39 to 55.38, P〈0.000 01）, and was lower in the intraoperative blood loss （WMD=-107.84, 95%CI -208.96 to -6.73, P〈0.04）; but there was no significant difference be- tween the two groups in terms of hospital stays （WMD=-3.78, 95%CI -9.60 to 2.04, P=0.20） or postoperative complications （WMD=0.69, 95%CI 0.37 to 1.29, P=0.25）. Conclusion As a minimally invasive technique, laparoscopic left hepatectomy has advantages of small abdominal incision and less intraoperative blood loss, and it is helpful to improve the quality of life for patients. Due to the limitation of quantity and quality of the included studies, it is hard to estimate the impact of bias on the reliability of this conclusion. We advise to perform more high quality, large scale and multicenter studies with adequate follow-up in the future.