肝实质离断方法疗效对照Meta分析

Meta-analysis of of evaluation various technigues of evaluation various technigues of liver parenchymal transection

目的对传统钳夹法与其他技术在肝实质离断中的疗效进行综合比较和荟萃分析。方法选取发表于2014年6月前对比传统钳夹法与其他肝实质离断方法(Ligsure、Tissue Link、CUSA、RFA、切割闭合器、解剖刀及水刀)的英文随机对照试验进行Meta分析。结果共纳入12篇随机对照试验,1039例肝切除病人。Meta分析显示其他断肝技术较传统钳夹法在术后并发症、胆漏、死亡率、输血率方面差异无统计学意义。无任何一项纳入研究显示其他断肝技术较传统钳夹法在手术时间、术后肝功能恢复存在显著性优势,仅分别有一项研究显示其他断肝技术较传统钳夹法在术中失血量和住院时间上存在优势。结论 Meta分析显示,其他断肝技术较传统钳夹法无显著性优势。在适当选择的病人中,传统钳夹法仍是最为经典的肝实质离断方法。

Objective To evaluate efficacy of the clamp-crushing technique versus other transection techniques during liver surgery. Methods Randomized controlled trials （RCTs） comparing the clamp-crushing technique and other method of hepatic transection that were published before June 2014 were retrieved and subjected to this systematic review and Meta-analysis. Results Twelve RCTs evaluating 1039 patients were included in this Meta-analysis. No significant difference was observed between the clamp-crushing and other transection techniques in the incidence of overall morbidity （RR=0.99, 95%CI： 0.84-1.17, P=0.91）, biliary leakage （RR=1.02, 95%CI： 0.70-1.49, P=0.91）, mortality （RR=2.16, 95%CI：0.84-5.58, P=0.11） and transfusion rates （RR=1.25, 95%CI：0.96-1.63, P=0.10）. None of the identified RCTs demonstrated a clinically important benefit of other transection technique in terms of operative time, parenchymal injury, blood loss and hospital stay, except one RCTs showed the RF-LR group had significantly reduced total intraoperative blood loss and another RCTs showed the Ligsure group had significantly reduced hospital stay. Conclusions Any alternative transection technique did not exhibit any significant advantage over the clamp-crushing. The Clamp-crush technique is advocated as the method of choice in elective hepatic resection.