门静脉结扎与栓塞在肝切除术中应用的Meta分析

Portal vein ligation versus portal vein embolization for hepatectomy:A Meta-analysis

目的系统评价门静脉结扎(PVL)和门静脉栓塞(PVE)后肝切除前剩余肝体积(FLR)增长率和其他围手术期结局指标。方法检索相关数据库,收集关于PVL与PVE在肝切除术中应用的随机对照试验(RCT)或临床对照试验(CCT),提取相关数据后,采用Rev Man5.3软件进行Meta分析。结果最终纳入8项研究,共438例病人。Meta分析结果显示:PVE组与PVL组FLR增长率、术后病死率、肝功能衰竭和并发症等方面差异无统计学意义。然而,联合肝脏分隔和门静脉结扎的二步肝切除术(ALPPS)较PVE能明显增加FLR。结论 PVL与PVE在肝切除术中有着相似的FLR增长率、术后病死率和并发症。ALPPS相比PVE能明显加速FLR增长。

Objective To systematically review the growth rate in future liver remnant （FLR） and perioperative outcomes after portal vein ligation （PVL） and portal vein embolization （PVE） before hepatectomy. Methods Such databases as MEDLINE, EMBASE, PubMed, Cochrane Library, CNKI, VIP, WanFang Data were electronically searched for randomized controlled trials （RCTs） or clinical controlled trials （CCTs） on application of portal vein ligation versus portal vein embolization for staged hepatectomy. The meta-analysis was performed using RevMan 5.3 software. Results A total of 8 studies were included with a total of 438 patients. The results of meta-analysis showed that： There was no difference in the increasement in FLR between PVE group versus PVL group （RR=6.04, 95% CI：-0.23-12.32, P〉 0.05）. Similarly, there was no difference in the interval time, complications after PVE/PYL, progression diseased after PVE/PVL, mortality, postoperative liver failure, morbidity and resectability in the two groups after hepatectomy. However, in a subset analysis comparing FLR with PVE and PVL, there was a significant increasement in FLR in favor of ALPPS （RR=30.14, 95% CI： 4.84-55.44, P〈 0.05）. Conclusion PVL and PVE for staged hepatectomy have a similar growth rate in FLR, mortality and morbidity rates in the hepatectomy. The ALPPS procedure results in an improved growth rate in FLR compared with PVE.