腹腔镜与开腹肝切除术比较治疗肝癌的Meta分析

Laparoscopic Hepatectomy versus Open Hepatectomy for Hepatocellular Carcinoma: A Meta-Analysis

目的系统评价腹腔镜肝切除术(laparoscopic hepatectomy,LH)与开腹肝切除术(open hepatectomy,OH)治疗肝癌(hepatocellular carcinoma,HCC)的疗效及安全性。方法计算机检索PubMed、EMbase、MEDLINE、SCI、CNKI、CBM、WanFang Data和The Cochrane Library(2012年第3期),收集LH与OH治疗HCC的随机或非随机同期对照试验,检索时限截止到2012年8月。由两名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用RevMan 5.1软件进行Meta分析。结果纳入13个非随机对照试验,共701例患者。Meta分析结果显示:LH治疗HCC较OH术中出血量少[MD=–144.09,95%C(I–194.25,–93.94),P<0.000 01],住院天数短[MD=–5.48,95%CI(–7.10,–3.85),P<0.000 01],术后并发症少[OR=0.43,95%CI(0.27,0.66),P=0.000 1]。但两组在手术时间[MD=–0.64,95%CI(–22.95,21.68),P=0.96]、围手术期死亡率、3～5年生存率、无瘤生存率等方面差异无统计学意义。结论 LH治疗HCC较OH具有创伤小、术中出血量较少、住院时间短、术后并发症少等特点,并在手术时间、围手术期死亡率、3～5年生存率等方面与OH无明显差异。因此,在严格掌握LH治疗HCC适应证的前提下,采用LH治疗肝癌是安全可行的。由于纳入研究数量和质量存在局限性,上述结论仍需大样本、高质量的RCT进一步验证。临床医生应根据HCC患者的具体情况,综合评估病情,选择最佳的治疗方式。

Objective To systematically evaluate the effectiveness and safety of laparoscopic hepatectomy （LH） versus open hepatectomy （OH） for hepatocellular carcinoma （HCC）. Methods Databases including PubMed, EMbase, MEDLINE, SCI, CNKI, CBM, WanFang Data and The Cochrane Library （Issue 3, 2012） were searched to collect the ran- domized controlled trails （RCTs） and non-RCTs about LH versus OH for HCC. The retrieval time was from inception to August 2012. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. Then the meta-analysis was conducted using RevMan 5.1 software. Results A total of 13 non-RCTs involving 701 patients were included. The results of meta-analysis showed that： Com- pared with OH, LH had lesser amount of intraoperative bleeding （MD=-144.09, 95%CI -194.25 to -93.94, P〈0.000 01）, shorter hospital stay （MD=-5.48, 95%CI -7.10 to -3.85, P〈0.000 01）, and lower postoperative complications （OR=0.43, 95%CI 0.27 to 0.66, P=0.000 1）. But there were no differences between the 2 groups in operation time （MD=-0.64, 95%CI -22.95 to 21.68, P=0.96）, perioperative death rate, 3-5 year survival rate, and tumor free survival rate. Conclusion LH is superior to OH in treating HCC for it is associated with smaller wound, lesser operative blood loss, shorter hospital stay, and lower postoperative complications. And it is similar as OH in operation time, perioperative death rate and 3-5 year survival rate. So LH is safe and feasible for treating HCC when its indications are strictly controlled. However, for the quantity and quality limitation of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for HCC patients according to an integrative disease assessment.