半肝血流阻断法与Pringle法在肝切除术应用中安全性与有效性比较的Meta分析

Safety and Ef ectiveness of Hemihepatic Blood Flow Occlusion versus Pringle's Maneuver during Hepatectomy: A Meta-Analysis

目的系统评价半肝血流阻断法与Pringle法在肝切除应用中的安全性和有效性。方法计算机检索h e Cochrane Library(2013年第8期)、PubMed、EMbase、CBM、CNKI、VIP和WanFang Data,查找所有比较半肝血流阻断术与Pringle法应用于肝切除的随机对照试验(RCT),检索时限均为从建库至2013年8月。同时追溯纳入研究的参考文献。由2名研究者根据纳入与排除标准独立筛选文献、提取资料并评价纳入研究的方法学质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入7个RCT,包括624例患者。结果显示:①手术安全性方面:Pringle法的手术时间少于半肝血流阻断法[SMD=0.34,95%CI(0.02,0.66),P=0.04],但两者术中失血量、术中输血需求比、住院时间、手术并发症等指标无明显差异。②有效性方面:半肝血流阻断法的术后第3天ALT水平[SMD=–0.71,95%CI(–1.28,–0.14),P=0.02]、第7天ALT水平[SMD=–1.73,95%CI(–2.85,–0.62),P=0.002]、第1天AST水平[SMD=–0.74,95%CI(–1.38,–0.09),P=0.03]、第7天AST水平[SMD=–0.99,95%CI(–1.26,–0.71),P<0.000 01]、第3天TBIL水平[SMD=–0.34,95%CI(–0.57,–0.10),P=0.005]及第7天TBIL水平[SMD=–0.52,95%CI(–1.02,–0.01),P=0.04]均低于Pringle法。结论与Pringle法相比,半肝血流阻断法在减轻肝脏缺血再灌注损伤以及促进肝切除患者术后肝功能恢复方面更好。因纳入研究的数量及样本量较少,且受质量限制,一些主要的测量指标报道过少,缺乏足够的信息进行分析,所以上述结论仍需开展大样本、多中心、高质量的RCT进一步验证。

Objective To systematically review Pringle＇s maneuver during hepatectomy. Methods the efficacy and safety of hemihepatic blood flow occlusion versus We electronically searched The Cochrane Library （Issue 8, 2013）, PubMed, EMbase, CBM, CNKI, VIP and WanFang Data for randomized controlled trials （RCTs） about hemihepatic blood flow occlusion versus Pringle＇s maneuver during hepatectomy. The duration of search was from the inception of the databases to August 2013. Meanwhile, references of the included studies were also retrieved. After literature selection, data extraction and quality assessment conducted by two reviewers independently, meta-analysis was conducted using RevMan 5.2 software. Results Seven studies involving 624 patients were finally included. The results of meta-analysis showed that： a） for safety, Pringle＇s maneuver was shorter than hemihepatic blood flow occlusion in operation time （SMD=0.34, 95%CI 0.02 to 0.66, P=0.04）. But they were alike in intraoperative blood loss, transfusion requirements, hospitalization time, and complications, b） For effectiveness, Pringle＇s maneuver was lower than hemihepatic blood flow occlusion in the levels of 3^rd day ALT （SMD= -0.71, 95%CI -1.28 to -0.14, P=0.02）, 7th day ALT （SMD= -1.73, 95%CI -2.85 to -0.62, P=0.002）, 1^st day AST （SMD= -0.74, 95%CI -1.38 to -0.09, P=0.03）, 7th day AST （SMD= -0.99, 95%CI -1.26 to -0.71, P〈0.000 01）, 3rd day TBIL （SMD= -0.34, 95%CI -0.57 to -0.10, P=0.005）, and 7th day TBIL （SMD= -0.52, 95%CI -1.02 to -0.01, P=0.04）. Conclusion Compared to the Pringle＇s maneuver, hemihepatic blood flow occlusion during hepatectomy could promote the recovery of liver function. However, the number of the included RCTs in the review is small and the quality is low, some of the main information is not reported and the information for analysis lacks. Therefore, the aforementioned conclusion needs to be verified by conducting more large-scale, multicenter and high-quality RCTs.