腹腔镜与开腹右半肝切除治疗肝肿瘤疗效比较的Meta分析

Efficacy of laparoscopic versus open right hemihepatectomy for liver tumor: a Meta-analysis

目的:比较肝肿瘤行腹腔镜右半肝切除(LRH)与开腹右半肝切除(ORH)的临床疗效。方法:计算机检索英文及中文数据库关于LRH与ORH治疗肝肿瘤的对照研究,检索时间最后为2018年4月。对纳入的文献进行质量评价和数据提取后,采用RevMan 5.3软件行Meta分析。结果:共纳入7项研究,共计472例患者,其中LRH组207例,ORH组265例。Meta分析,结果显示,与ORH组比较,LRH组术中出血量减少(WMD=-166.14,95%CI=-254.59～-77.68,P<0.000 2)、并发症发生率降低(OR=0.35,95%CI=0.21～0.57,P<0.000 1)、住院时间缩短(WMD=-4.97,95%CI=-6.13～-3.81,P<0.000 01),但手术时间延长(WMD=51.39,95%CI=14.88～87.90,P=0.006);在输血率、病死率、手术切缘及肿瘤大小等方面无统计学差异(均P>0.05)。结论:LRH治疗肝肿瘤的临床效果与ORH无差异,且安全性好,然而该结论仍需更多高质量的研究予以验证。

Objective: To compare the clinical efficacy of laparoscopic right hemihepatectomy(LRH) and open right hemihepatectomy(ORH) in treatment of liver tumor. Methods: The controlled studies comparing LRH and ORH in treatment of liver tumor published in English and Chinese were searched through online databases. The retrieval time was up to April 2018. After the quality evaluation and data extraction of the included studies, Meta-analysis was conducted by using RevMan5.3 software.Results: Seven studies were finally included involving 472 patients, with 207 cases in LRH group and 265 in ORH group. The results of Meta-analysis showed that in LRH group compared with ORH group, the intraoperative blood loss was reduced(WMD=–166.14, 95% CI=–254.59––77.68, P<0.000 2), incidence of complications was decreased(OR=0.35, 95% CI=0.21–0.57, P<0.000 1) and length of postoperative hospital stay was shortened(WMD=–4.97, 95% CI=-6.13––3.81, P<0.000 01), while the operative time was prolonged(WMD=51.39,95% CI=14.88–87.90, P=0.006);no significant differences were noted with regard to the transfusion rate, mortality, surgical margin and tumor size(all P>0.05). Conclusion: LRH shows no difference in efficacy for the treatment of liver tumor compared with ORH, and also has better safety. However, this conclusion still needs to be verified by more high-quality studies.