ALPPS与门静脉栓塞二步法肝切除术治疗剩余肝体积不足的肝脏恶性肿瘤的临床疗效的Meta分析

Meta-analysis of the outcomes of associating liver partition and portal vein ligation for staged hepatectomy versus portal vein embolization for the treatment of liver cancer with insufficient future liver remnant

目的探讨联合肝脏分隔和门静脉结扎的分阶段肝切除术(ALPPS)和门静脉栓塞(PVE)两种术式对剩余肝脏体积(FLR)不足的肝脏恶性肿瘤治疗的可行性、安全性和有效性。方法检索PubMed、Cochrane Library、Embase、中国知网、维普数据库,收集国内外相关ALPPS与PVE的临床对比研究,采用RevMan 5.3进行Meta分析。结果纳入10篇临床对照文献(9篇为队列研究,1篇为随机对照研究),共620例研究者(ALPPS组165例,PVE组455例)。分析结果表明,二步手术完成率(OR=6.04,95% CI:2.97~12.31,Z=4.96),FLR增长率(MD=19.91,95% CI:8.64~31.18,Z=3.46),二步手术间隔时间(MD=-30.48,95%CI:-37.87^-23.09,Z=8.09),R0切除率(OR=2.29,95%CI:1.07~4.90,Z=2.13)等差异均有统计学意义(P<0.05);而90 d内病死率、总并发症发生率、术后肝功能衰竭发生率及总住院时间无统计学意义(P值均>0.05)。结论与PVE相比,ALPPS对部分FLR不足的中晚期肝癌患者是安全有效的治疗方案。但ALPPS和PVE的临床应用均存在一定的局限性。

ObjectiveTo explore the feasibility, safety and efficacy of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and portal vein embolization (PVE) for the treatment of liver cancer with insufficient future liver remnant (FLR). MethodsThe data regarding the clinical controlled trials in comparison of ALPPS and PVE in liver surgery were collected from the both domestic and international publications searched through the datebases of PubMed, Cochrane Library, Embase, CNKI, and VIP.Meta analysis was performed by RevMan 5.3 software. ResultsTotal 10 studies with clinical control were analyzed (9 cohort studies and 1 randomized controlled study).A total of 620 patients were included, with 165 cases in ALPPS group, 455 cases in PVE group.Results of Meta-analysis showed that there was statistically significant difference (P<0.05) between the two groups in the completion rate of two-steps surgery (OR=6.04, 95%CI: 2.97-12.31, Z=4.96), FLR growth rate (MD=19.91, 95% CI: 8.64-31.18, Z=3.46), two-steps surgical interval (MD=-30.48, 95%CI:-37.87--23.09, Z=8.09), and R0 resection rate (OR=2.29, 95%CI=1.07-4.90, Z=2.13).While there was no significant differences between the two groups in the mortality rate of postoperative within 90-days, postoperative the total complication rates, postoperative liver failure, and total hospital stay (all P>0.05). ConclusionsCompared to the PVE procedures, ALPPS appears an effective treatment method for liver tumor with insufficient FLR.Therefore, the applications of ALPPS and PVE are limited and depending on further investigation.