我国腹腔镜和常规肝切除治疗原发性肝细胞肝癌近期及远期疗效比较的META分析

Effectiveness and safety of laparoscopic versus open left hepatectomy for primary cancer: A meta analysis

目的:系统评价国内腹腔镜与开腹手术切除治疗肝癌的近期及远期疗效。方法:计算机检索ISI Web of Knowledge、MEDLINE、EMbase、PubMed,万方数据库、中国知网、维普资讯,收集国内研究机构完成的腹腔镜切除与开腹切除比较治疗肝癌的对照试验。数据提取和文献质量评价由2名评价员独立进行。采用RevMan 5.2对数据进行统计分析。结果:未获得随机对照试验,共纳入10个国内临床同期对照试验,累计病例552例。Meta分析结果显示:1)腹腔镜肝癌切除安全性更佳。可有效减少出血量[WMD=-83.3,95%CI(-124.3,-42.3),P<0.000 1],减少肝门阻断的使用[OR=0.17,95%CI(0.06,0.52),P=0.002],减少术后并发症的发生[OR=0.3,95%CI(0.16,0.59),P=0.000 4],明显缩短住院时间[WMD=-4.85,95%CI(-6.31,-3.38),P<0.000 01]。2)腹腔镜肝癌切除远期疗效无不良影响。腹腔镜与开腹手术组间的肿瘤复发率[OR=1.05,95%CI(0.6,1.85),P=0.87]及1、3、5年总体生存率[OR=1.40,95%CI(0.76,2.56),P=0.28;OR=1.15,95%CI(0.74,1.81),P=0.53;OR=0.91,95%CI(0.57,1.45),P=0.68]和1、3年无瘤生存率[OR=1.89,95%CI(0.96,3.7),P=0.16;OR=1.57,95%CI(0.94,2.61),P=0.18]差异无统计学意义(P>0.05)。结论:对于病变位于CouinaudⅡ、Ⅲ、Ⅳ、Ⅴ及Ⅵ段,肿瘤直径<10 cm,肝功能在Child B级以上的肝细胞癌患者,腹腔镜肝切除术对长期疗效无不良影响,且近期疗效更佳。

Objective： To evaluate the effectivensee and safety of laparoscopic hepatectomy（LH） versus open hepatectomy（OH） for Primary Cancer. Methods： Databases including ISI Web of Knowledge, MEDLINE, EMbase, PubMed, CNKI, VIP and WANFANG were searched to collect clinical trials on laparoscopic versus conventional open 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 RevMan 5.2 software. Results： No randomized controlled trials were colrected,and a total of 10 clinical concurrent controlled trials involving 537 patients were included finally. The results of meta-analysis showed that： 1）Laparoscopic hepatectomy can be more safyty, the laparoscopic group was lower in the intraoperative blood Ioss[WMD=-83.3, 95%CI （-124.3, -42.3）, P〈 0.000 1], less ues of portal clamping [0R=0.17, 95% CI （0.06, 0.52）, P=0.O02], less hospital stays [WMD=-4.85, 95%CI （-6.31, -3.38）, P 〈0.000 01] or postoperative complications[OR= 0.3,95%C1（0.16,0.59）, P=O.O00 4]. 2）There was no significant difierenc of tumor recurrence [OR= 1.05, 95%CI （0.6,1.85）, P=O.87]and 1-and3-yearrecurrence-freesurvival[OR=1.89, 95%CI （0.96,3.7）, P=0.16, 0R=1.57, 95%CI （0.94, 2.61）, P=0.18] and 1-, 3 and 5- year pooled of overall survival [0R=1.40,95%CI （0.76,2.56）, P=0.28; 0R=1.15, 95%C1（0.74, 1.81）, P=0.53, 0R=0.91, 95% CI （0.57, 1.45）, P=0.68] between two groups. Conclusion： Compare with OH, LH may have short-term advantages in terms of blood loss and postoperative morbidity for HCC. Both procedures have similar long-term outcomes.