腹腔镜与开腹手术治疗肝细胞癌疗效的Meta分析

Meta-Analysis of Laparoscopic Versus Open Hepatectomy for Hepatocellular Carcinoma

目的系统评价腹腔镜与开腹手术治疗肝细胞癌的疗效。方法计算机检索PubMed、中国期刊全文数据库、万方数据库、中国博硕士学位论文数据库及中国重要会议论文数据库2000～2011年发表的有关腹腔镜肝切除术和开腹肝切除术治疗肝细胞癌的相关文献,采用RevMan 5.0进行Meta分析。结果共纳入11项临床对照试验,包括781例患者,其中经腹腔镜手术治疗325例,开腹手术治疗456例。Meta分析结果显示,与开腹手术相比较,腹腔镜肝切除术能明显缩短手术时间〔加权均数差值(WMD)=-20.85,95%CI(-29.54,-12.16),P<0.000 01〕,减少术中出血量〔标准化均数差值(SMD)=-0.42,95%CI(-0.65,-0.19),P=0.000 4〕,降低术后并发症发生率〔优势比(OR)=0.43,95%CI(0.28,0.65),P<0.000 1〕,缩短住院时间〔WMD=-4.32,95%CI(-6.29,-2.34),P<0.000 1〕。但术后复发率(P=0.80)和术后1年总生存率(P=0.98)、3年总生存率(P=0.41)、5年总生存率(P=0.12)以及1年无瘤生存率(P=0.15)、3年无瘤生存率(P=0.62)和5年无瘤生存率(P=0.99)差异均无统计学意义。结论对于病变位于CouinaudⅡ、Ⅲ、Ⅳ、Ⅴ及Ⅵ段,其直径小于5 cm,并且不影响第一和第二肝门血管的暴露,肝功能在Child B级以上的肝细胞癌患者,在条件允许的情况下可优先考虑腹腔镜肝切除术。

Objective To systematically evaluate the efficiency of laparoscopic hepatectomy （LH） and conventional open bepatectomy （OH） in patients with hepatocellular carcinoma （HCC）. Methods The literatures about the therap- eutic effect of LH and OH on hepatocellular carcinoma were collected from PubMed, Chinese Journal Full-text Database （CJFD）, Wanfang Database, China Doctor/Master Dissertations Full-text Database （CDMD）, and China Proceedings of Conference Full-text Database （CPCD） from 2000 to 2011. RevMan 5.0 software was used for data analysis. Results ]Eleven controlled clinical trials were included in this analysis. These studies included a total of 781 patients： 325 lxeated with LH and 456 treated with OH. The results of meta-analysis showed that LH group had shorter operation time [i WMD=-20.85, 95% CI （-29.54, -12. 16）, P 〈 0. 000 01 ~, less operative blood loss [SMD=-O. 42, 95% C! （-0. 65, -0. 19）, P=-0. 000 4], a lower postoperative morbidity rate ~OR=O. 43, 95% CI （0, 28, 0. 65）, P〈0. 000 1 ~, ~ind shorter hospitalization days [ WMD=-4. 32, 95% CI （-6. 29, -2. 34）, P〈0. 000 1 ] than OH group. There was no ：dgnificant difference in postoperative recurrence （P=-0. 80）, overall survival in 1-year （P=-0. 98）, 3-year （P=-0. 41）, and ：5-year （P=0. 12）, and in disease-free survival in 1-year （P=-O. 15）, 3-year （P=-0. 62）, and 5-year （P=-O. 99） between the two groups. Conclusions For the patients with hepatocellular carcinoma localized to the Couinaud H, m, IV, V, and VI segments with a maximum lesion size of 5 cm, as well as the tumor has no effect on the exposure of blood vessel of the first and second hepatic portal, and the liver functions are classified as Child B or A high grade, the laparoscopic liver resection is priority considered in the conditions allow.