腹腔镜与开腹肝癌切除术手术疗效的Meta分析

Laparoscopic versus open hepatectomy for hepatocellular carcinoma: a meta-analysis

目的:采用Meta分析方法分析腹腔镜与开腹手术对肝癌患者的长期疗效与安全性。方法:计算机检索PubMed、中国生物医学文献数据库及万方数据库,收集比较腹腔镜切除与开腹切除治疗肝癌的非随机临床对照试验研究。采用Cochrane协作网专用软件RevMan 5.1对数据进行统计分析。结果:(1)手术时间:10个研究(n=709)的手术时间差异无统计学意义[均数差值(MD)=0.01 min,95%CI(-0.19,0.16),P=0.879];(2)术中出血量:9个研究(n=633)的术中出血量差异无统计学意义[MD=0.03 ml,95%CI(-0.14,0.21),P=0.715];(3)术中输血率:7个研究(n=552)的术中输血率差异有统计学意义[(RR)=2.72,95%CI(1.29,5.74),P=0.009];(4)并发症:10个研究(n=709)的并发症发生率差异有统计学意义[RR=0.52,95%CI(0.31,0.88),P=0.015];(5)1、3、5年无瘤生存率:5个研究(n=304)的1、3、5年无瘤生存率差异无统计学意义[RR=0.94,95%CI(0.87,1.02),P=0.130;RR=1.02,95%CI(0.86,1.21),P=0.841;RR=1.17,95%CI(0.84,1.64),P=0.355];(6)1、3、5年生存率:7个研究(n=440)的1、3、5年生存率差异无统计学意义[RR=0.97,95%CI(0.92,1.03),P=0.366;RR=0.98,95%CI(0.88,1.09),P=0.697;RR=1.03,95%CI(0.85,1.25),P=0.766]。结论:与开腹手术相比,腹腔镜手术治疗肝癌具有术中输血少、术后并发症发生率低等优点,手术时间,术中出血量,术后1、3、5年生存率及无瘤生存率无显著差异。

Objective：To evaluate long-term efficacy and safety of laparoscopic and open hepatectomy for hepatocellular carci- noma. Methods：PubMed, CBM and WanFang database were searched for non-random controlled clinical trials concerning laparoscopic compared with open hepatectomy for hepatocellular carcinoma. The Cochrane network RevMan vS. 1 software was used for statistics analysis. Results： （ 1 ） operation time ： 10 studies （ n = 709 ） showed no significant difference between each other [ MD = 0.01 rain ,95% CI （-0.19,0.16） ,P = 0. 879 ] ;（2）Intraoperative blood loss ：9 studies （n = 633 ） showed no significant difference [ MD = 0.03 ml,95% CI（ -0.14,0.21 ） , P = 0. 715 ] ; （ 3 ） Intraoperative blood transfusion rates ： 7 studies （ n = 552 ） showed significant difference [ RR = 2.72,95 % CI （1.29,5.74） ,P = 0. 009 ] ; （4） Complications ： 10 studies （ n ： 709 ） showed significant difference [ RR = 0.52,95% CI （ 0.31,0.88 ） , P = 0.015 ] ; （ 5 ） One, three, five years disease-free survival rate ： 5 studies （ n = 304 ） showed no significant difference [RR =0.94,95%CI（0.87,1.02） ,P =0. 130;RR = 1.02,95% CI（0. 86,1.21） ,P =0. 841;RR = 1.17,95% CI（O. 84,1.64） ,P = O. 355 ; （6） One, three, five years of overall survival rate ： 7 studies （ n = 440 ） showed no significant difference [ RR = 0.97,95 % CI （ 0.92,1.03 ）, P = 0. 366 ; RR = 0.98,95 % CI （ 0.88,1.09 ）, P = 0.697 ; RR = 1.03,95 % CI （ 0.85,1.25 ）, P = 0. 766 ]. Conclusions ： Laparoscopic hepatectomy shows less intraoperative transfusion rate and postoperative complications with no significant difference in operation time, intraoperative bleeding and one, three ,five years disease-free and overall survival rate compared with open hepatectomy.