精准肝切除治疗原发性肝癌临床效果的Meta分析

Meta-analysis of liver resection for hepatocellular carcinoma precise clinical effects

目的:系统评价精准肝切除对治疗原发性肝癌的临床效果。方法:计算机检索Pubm ed、中国生物医学数据库、C N KI及万方数据库关于精准肝切除与常规肝切除治疗原发性肝癌的随机对照试验(R C T)及临床对照试验(C C T)。运用R ev M an 5.3软件对精准肝切除与常规肝切除在术中、术后及预后疗效指标进行M eta分析。结果:共纳入4个R C T和5个C C T,共774例患者。精准肝切除与常规肝切除相比,显著缩短了住院时间(M D=-3.22,95%C I:-3.93^-2.51,P<0.000 01),减少了术中出血量(M D=-228.61,95%C I:-308.46^-148.76,P<0.000 01),明显降低了切缘残余率(O R=0.12,95%C I:0.04~0.35,P<0.000 1),降低了1年复发率(O R=0.50,95%C I:0.32~0.78,P=0.003),提高了1年存活率(O R=2.16,95%C I:1.34~3.46,P=0.001),加快了术后谷丙转氨酶(M D=-122.00,95%C I:-195.05~48.95,P=0.001)与谷草转氨酶(M D=-160.79,95%C I:-224.81^-96.77,P<0.000 01)及总胆红素恢复(M D=-8.74,95%C I:-10.57^-6.91,P<0.000 01),而术后白蛋白恢复无显著差别(P=0.22)。显著减少了总并发症发生率(O R=0.29,95%C I:0.19~0.45,P<0.000 01),其中胸腹腔积液发生率明显减少(O R=0.41,95%C I:0.22~0.75,P=0.004),胆漏发生率降低(O R=0.32,95%C I:0.12~0.86,P=0.02),而肝衰竭、感染及消化道出血发生率差异无统计学意义(P>0.05)。结论:精准肝切除对于原发性肝癌的治疗较常规肝切除具有良好临床的效果,不仅能够彻底清除病灶,而且降低了复发率,提高了患者生存率,加快术后肝功能恢复,减少术后并发症,具有创伤小、恢复快、安全有效等优点,但是由于试验样本数量偏少,期待更多高质量试验的证据。

Objective：To evaluate the precise system for the treatment of primary liver resection liver cancer clinical results.Methods：PubMed,CNKI Chinese Biomedical Database（CBM）,and Wanfang databases weresearched to identify randomized controlled trialsnd controlled trials that assessed the efficacyof precise hepatectomy and Conventional hepatectomy in treatment of primary liver cancer.Using RevMan 5.3 software for precise liver resection and conventional liver resection in the postoperative prognosis of outcome measures and Meta-analysisResults.Result：A total of four randomized controlled trials and five controlled clinical trials,A total of 774 cases of patients.Compared to Precise liver resection and conventional liver resection,Significantly shorten the hospital stay（MD=-3.22,95％CI：-3.93 ～-2.51,P＜0.000 01）,Reduces blood Ioss（MD=-228.61,95％ CI：-308.46～-148.76,P＜ 0.000 01）,Significantly reduces the residual ratio of margin （OR =0.12,95％ CI：0.04 ～ 0.35,P ＜ 0.000 1）,Reducing the 1-year recurrence rate （OR=0.66,95％CI：0.32-0.78,P=0.003）,Improved one-year survival rate（OR=2.16,95％ CI：1.34-3.46,P=0.001）,Alanine aminotransferase accelerated postoperative recovery（MD=-122.00,95％CI：-195.05-48.95,P=0.001） and aspartate aminotransferase recovery （MD=-160.79,95％ CI：-224.81 ～-96.77,P＜0.000 01）,And total bilirubin recovery（MD=-8.74,95％CI：-10.57～-6.91）,P＜ 0.000 01）,The postoperative recovery of albumin was no significant difference（P=0.22）.Significantly,The incidence of abdominal effusion which significantly reduced （OR=0.41,95％CI：0.22 ～0.75,P=0.004）,Reduced incidence of bile leakage （OR=0.32,95％CI：0.12-0.86,P=0.02）,And liver failure,infection and the incidence of gastrointestinal bleeding was no significant difference（P＞ 0.05）.Conclusions：Existing studies show,precise liver resection for the treatment of primary liver cancer compared with conventional liver resection with good clinical results,not only able to completely remove the lesion,And reduces the recurrence rate and improve the survival rate,accelerate postoperative recovery of liver function,reduce postoperative complications,with less trauma,quicker recovery,safe,effective,etc.However,due to the small sample size,expect more high-quality trials provide evidence.