结直肠癌肝转移肝切除术前门静脉栓塞临床疗效的Meta分析

Clinical effectiveness of preoperative portal vein embolization in the treatment of colorectal cancer liver metastases： a meta-analysis

目的 探讨在结直肠癌肝转移（CRLM）治疗中肝切除术前门静脉栓塞（PVE）的临床疗效.方法 通过检索PubMed、EMBASE、CBM等据库,收集公开发表的有关比较肝切除术前PVE与无需PVE直接手术临床疗效的对照研究,对两组的术后并发症发生率、肝衰竭发生率、死亡率及5年生存率进行Meta分析.结果 共纳入文献8篇,676例患者,其中术前PVE组253例,直接手术组423例,分析显示术前PVE组术后并发症发生率高于直接手术组[比值比（OR）=1.91,95％可信区间（CI）：1.02 ～2.15,P＜0.05],术前PVE组与直接手术组术后肝衰竭发生率（OR=0.66,95％ CI：0.34～1.30）、死亡率（OR=1.14,95％ CI：0.43 ～3.01）、5年生存率[风险比（HR）=1.00,95％ CI：0.73 ～ 1.36]的差异均无统计学意义（P＞0.05）.结论 肝切除术前PVE可使预计术后残存肝脏容积不够、手术风险大而被视为不可切除的肝转移患者获得相对安全的手术切除机会,其远期预后与无需PVE的初诊可切除患者相当.

Objective To investigate the clinical effectiveness of preoperative portal vein embolization （PVE） in the treatment of colorectal cancer liver metastases （CRLM）.Methods All eligible case-control studies comparing the clinical effectiveness of preoperative PVE or without PVE before hepatectomy were searched out from PubMed,EMBASE and CBM database.Data on the rate of postoperative complications,liver failure and mortality and the 5-year overall survival rate were meta-analyzed.Results A total of 8 studies comprising 676 patients were included,including 253 patients in the PVE group and 423 patients in the no PVE group.The rate of postoperative complications was higher in the PVE group than in the no PVE group,and there were no significant differences in the rate of postoperative liver failure and mortality and the 5-year overall survival rate between the two groups.Conclusion Patients with unresectable liver metastases because of insufficient future liver remnant and high risk of surgery could get a chance of relative safe resection,and the long-term results were comparable to the patients with initially resectable liver metastases which didn＇ t need PVE.