非原位肝切除技术安全性、可行性和有效性的系统评价

Systematic review of feasibility, safety and efficacy of ex situ liver resection and autotransplantation

目的评价非原位肝切除术（ESLR）治疗侵犯肝静脉回流区域肝脏肿瘤的可行性、安全性和疗效。方法检索中国知网、万方数据库、维普数据库、PubMed、Medline、Embase、Chochrane、国际临床移植注册平台、移植电子图书馆等数据库，系统评价可行性、安全性和肿瘤疗效，就其中转异体移植率、并发症发生率、90 d死亡率进行总结分析。结果共有46篇文献报道191例ESLR（其中自体肝移植术101例，半离体肝切除术90例）。最常见的手术适应证是肝细胞癌（49例），其次为结肠癌肝转移（37例）、肝泡型包虫病（33例）、胆管细胞癌（26例）。手术成功率为84.5%（CI＝76.6%～90.1%）、中转异体移植率为13.5%（CI＝8.5%～21.0%）、总并发症发生率为58.1%（CI＝48.5%～67.1%）、Ⅲa级以上并发症发生率为43.1%（CI＝33.6%～53.1%）和90 d死亡率为19.5% （CI＝12.7%～28.8%）。结论ESLR是治疗侵犯肝静脉汇合区和肝后下腔静脉肿瘤的有效治疗措施。严格把握手术适应证、术前精确评估自体供肝＂质和量＂及精准的外科操作是手术成功的关键。

Objective To evaluate the feasibility, safety and efficiency of ex situ liver resection （ESLR） technique in patients with hepatocaval region involvement. Methods A systematic research of the data bases CNKI, Wan Fang, CQVIP, PubMed, CENTRAL, Medline, Embase, Cochrarie, International Clinical Transplantation Registration Platform and Transplant Library was performed. All the current data regarding the feasibility, safety, and oncological efficiency of ESLR was systematically reviewed. Feasibility, conversion to allo-transplantation rate, complication and 90-day mortality were analyzed. Results A literature search revealed a total of 46 publications with 191 patients who underwent ex situ liver resection （101 autotransplantation, 90 ante-situm liver resection）. The most common indication was hepatoeellular carcinoma （49）, followed by colorectal liver metastasis （37）, hepatic alveolar echinococeosis （33） and cholangiocarcinoma （26）. The feasibility rate was 84. 5%o （CI = 76. 6% -90. 1%）, the conversion to a11o- transplantation rate was 13.5%0 （ CI = 8.5% - 21.0% ） . Overall complication rate was 58.1% （ CI = 48.5 % - 67. 1% ） , and complications grade m a or higher occurred in 43.1% （ CI = 33.6% - 53.1%）. 90-day mortality was 19. 5% （ CI = 12. 7% - 28.8% ） . Conclusion ESLR and autotransplantafion technique is an effective surgical approach for hepatic tumor with hepatocaval region involvement. Strict control of surgical indications, preoperative evaluation and precise surgical technique is essential to success.