腹腔镜肝囊型包虫病手术疗效评价Meta分析

Meta-analysis of clinical efficacy of laparoscopic surgery for hepatic cystic echinococcosis

目的探讨腹腔镜肝脏囊型包虫病手术治疗的临床疗效及安全性。方法在Pubmed、Cochrane Library、万方医学等检索平台检索1992年1月至2017年11月文献,关键词为"肝囊型包虫病"、"包虫病"、"手术"、"腹腔镜"、"微创手术"、"echinococcosis","liver or hepatic","surgery","open","laparoscopic or minimal invasive"。对纳入研究的文献中关于治疗效果、并发症、住院时间、复发率相关数据进行提取并进行Meta分析。结果纳入文献共8篇,其中6篇回顾性病例对照研究,2篇前瞻性研究。共1 075例患者,腹腔镜组238例,开腹手术组837例。Meta分析结果显示腹腔镜组有较低的术后并发症发生率(OR=0.58,95%CI:0.38～0.87,P<0.05),较少的切口相关并发症(OR=0.34,95%CI:0.13～0.91,P<0.05),较短的住院时间(MD=-3.61,95%CI:-4.84～-2.38,P<0.05)。两组术后胆漏、残腔感染及积液、术后复发率比较差异无统计学意义(OR=0.87,0.51,0.50;P>0.05)。结论腹腔镜肝囊型包虫手术是安全的,可以达到和开腹手术相同的疗效。与开腹手术相比,其具有术后切口相关并发症发生率低和住院时间短等优势。

Objective To investigate the clinical efficacy and safety of laparoscopic surgery in the treatment of hepatic cystic echinococcosis.Methods Literatures published from January 1992 to November2017 were retrieved in database of PubMed,Cochrane Library and Wanfang data,etc.The searching keywords included hepatic cystic echinococcosis,echinococcosis,surgery,laparoscope,minimally invasive surgery,living or hepatic,open,laparoscopic or minimal invasive in both Chinese and English.Clinical data related to therapeutic effect,complications,length of hospital stay and recurrence rate were extracted for Meta-analysis from the included literatures.Results A total of 8 articles were eligible including6 retrospective case-control studies and 2 prospective studies.A total of 1 075 cases were recruited including238 cases in laparoscopic surgery group and 837 in open surgery group.In laparoscopic surgery group,the incidence of postoperative complications was significantly lower（OR=0.58,95%CI：0.38-0.87,P0.05）,the incidence of incision-related complications was significantly lower（OR=0.34,95%CI：0.13-0.91,P0.05）and the length of hospital stay was significantly shorter（MD=-3.61,95%CI：-4.84 to-2.38,P0.05）compared with those in open surgery group.No significant difference was observed in the incidence of postoperative bile leakage,residual cavity infection,hydrops and recurrence rate between two groups（OR=0.87,0.51,0.50;P0.05）.Conclusions Laparoscopic surgery is safe for cystic echinococcosis,it can achieve the same effect as open surgery.Compared with open surgery,laparoscopic surgery has the advantages of lower incidence of postoperative incision-related complications and shorter length of hospital stay.