肝切除术应用半肝与全肝入肝血流阻断法效果的Meta分析

Hemihepatic Inl ow Occlusion versus Total Hepatic Inl ow Occlusion in Liver Resection: A Meta-Analysis

目的系统评价在肝切除术中应用半肝入肝血流阻断(hemihepatic inl ow occlusion,HHO)与全肝入肝血流阻断(total hepatic inl ow occlusion,THO)的效果。方法计算机检索CENTRAL(2013年第1期)、PubMed、EMbase、CBM、CNKI和中华医学会数字化期刊系统,查找比较在肝切除术中应用HHO与THO效果的随机对照试验(RCT),检索时限均为从建库至2013年5月,并追溯纳入文献的参考文献。同时,手工检索已发表的资料和会议论文。由2位研究者根据纳入与排除标准独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.2软件进行Meta分析。结果最终纳入10个RCT,包括788例患者。Meta分析结果显示:HHO在降低术后第1天血清天冬氨酸氨基转移酶(AST)[WMD=–235.84,95%CI(–411.28,–60.40),P=0.008]和丙氨酸氨基转移酶(ALT)[WMD=–195.52,95%CI(–351.87,–39.16),P=0.01]水平,缩短AST[WMD=–3.83,95%CI(–4.52,–3.15),P<0.000?01]、ALT[WMD=–4.29,95%CI(–5.75,–2.84),P<0.000?01]和胃肠道的恢复时间[WMD=–1.52,95%CI(–2.75,–0.29),P=0.02]方面优于THO。随着手术器械的不断改进及手术经验的不断丰富,THO在缩短手术时间方面可能优于HHO。但两者在术中出血量、术中术后是否输血和住院时间方面无明显差异。结论肝切除术中应用HHO能减轻肝功能损害,缩短术后肝功能和胃肠道的恢复时间,但两者在术中出血量、术中术后是否输血和住院时间方面无明显差异。受纳入研究质量限制,上述结论尚待今后开展更多高质量研究加以验证。

Objective To assess the effectiveness of hemihepatic vascular occlusion （HHO） and total hepatic inflow occlusion （THO） which were applied in the liver resection. Methods Randomized controlled trials （RCTs） comparing HHO and THO in hepatectomy were electro- nically searched from CENTRAL （Issue 1, 2013）, PubMed, EMbase, CBM, CNKI and Digital Journals of Chinese Medical System. The English or Chinese version of relevant published and unpublished data and their references were also retrieved by hand. The last retrieval date was in May 2013. The data were extracted and the quality was evaluated by two reviewers independently, and then RevMan 5.2 software was used for data analysis. Results Ten RCTs involving 788 patients were finally included. The results of meta-analysis showed that, HHO reduced the levels of aspartate transaminase （AST） （WMD= –235.84, 95%CI –411.28 to –60.40, P=0.008） and alanine aminotransferase （ALT） （WMD= –195.52, 95%CI –351.87 to –39.16, P=0.01） in 1 day postoperatively. HHO also shortened the recovery time of AST （WMD= –3.83, 95%CI –4.52 to –3.15, P〈0.000 01） and ALT （WMD= –4.29, 95%CI –5.75 to –2.84, P〈0.000 01） postoperatively, and shortened the recovery time of gastrointestinal function （WMD= –1.52, 95%CI –2.75 to –0.29, P=0.02）. However, HHO was the same as THO in intraoperative haemorrhage and postoperative transfusion and hospital stay. Conclusion HHO applied in liver resection could relieve the damage of liver function, and shorten the recovery time of gastrointestinal function postoperatively. Due to the poor quality of the included studies, more high quality RCTs with longer follow-up are required to further verify the aforementioned conclusion.