联合血管切除在手术治疗肝门部胆管癌中作用的Meta分析

Combined vascular resection in surgical treatment of hilar cholangiocarcinoma: a Meta-analysis

目的：系统评价联合血管切除（VR）在肝门部胆管癌（HCCA）手术治疗中的作用。方法：系统检索国内外多个文献数据库,收集手术联合VR对比未联合VR治疗HCCA的文献,评估联合VR的安全性及疗效,并根据联合切除血管的类型分亚组分析。结果：共纳入27篇文献,总计3 218例HCCA患者,其中联合VR治疗888例（联合VR组）,未联合VR治疗2 330例（对照组）。Meta分析的总体结果显示,与对照组比较,联合VR组安全性方面降低（病死率：OR=2.83,95%CI=1.80~4.44;术后并发症：OR=2.48,95%CI=1.44~4.28）且疗效不佳（1、3、5年生存率：OR=0.60,95%CI=0.49~0.73、OR=0.57,95%CI=0.47~0.69、OR=0.61,95%CI=0.41~0.91）（均P〈0.05）。在门静脉切除亚组中,虽然术后并发症发生率较对照组高（P〈0.05）,但在其他有效性及安全性指标方面与对照组之间无统计学差异（均P〉0.05）;在肝动脉切除亚组中,所有的合并效应与总体的分析结果一致（均P〈0.05）。结论：对于仅有门静脉被侵犯的HCCA患者,手术联合VR是可行的,然而,一旦有肝动脉受累,则联合VR治疗需慎重施行。

Objective： To systematically evaluate the ef ect of combined vascular resection（VR） in surgical treatment of hilar cholangiocarcinoma（HCCA）.Methods： The literature of studies comparing surgical treatment of HCCA in combination with VR versus that without VR was collected by searching several national and international databases. h e safety and ei cacy of combined VR were evaluated, and the subgroups analysis was also performed according to the types of the simultaneously resected blood vessel.Results： Twenty seven studies with a total of 3 218 HCCA patients were included, of whom 888 cases underwent combined VR treatment（VR combination group）, and 2 330 cases had no combined VR treatment（controlgroup）. h e results of Meta-analysis for overall group showed that the safety proi le was unfavorable（mortality： OR=2.83, 95% CI=1.80–4.44; postoperative complications： OR=2.48, 95% CI=1.44–4.28） and the ei cacy was less favorable（1-, 3- and 5-year overall survival： OR=0.60, 95% CI=0.49–0.73; OR=0.57, 95% CI=0.47–0.69; OR=0.61, 95% CI=0.41–0.91） in VR combination group compared with control group（all P〈0.05）. In portal vein resection subgroup compared with control group, although the incidence of complications was increased（P〈0.05）, no dif erence was found in other variables（all P〉0.05）; in hepatic artery resection subgroup, all the pooled results were consistent with the overall i ndings（all P〈0.05）.Conclusion： In HCCA patients, surgical treatment combined with VR is feasible for those with portal vein invasion, but VR should be made cautiously if the hepatic artery is involved.