腹腔镜与开腹右肝切除治疗肝恶性肿瘤疗效比较的Meta分析

Laparoscopic versus Open Right Hepatectomy for Hepatic Malignancy:a Meta-analysis

目的 系统评价腹腔镜右肝切除术(laparoscopic right hepatectomy,LRH)与开腹右肝切除术(open right hepatectomy,ORH)治疗肝脏恶性肿瘤的手术有效性及安全性.方法 计算机系统检索PubMed,Embase,the Cochrane Library、CBM、CNKI及VANFUN数据库,收集LRH与ORH疗效比较的随机或非随机同期对照试验.按Cochrane系统评价方法筛选文献、提取资料并评价质量后,使用Review Manager 5.3版进行统计分析.连续变量通过均数差(MD)和95%置信区间(CI)计算,而二分类变量通过95% CI的比值比(OR)计算.结果 共纳入4篇合适的病例-对照研究(无随机对照试验),共有308例患者,LRH组98例,ORH组210例.Meta分析结果显示,LRH组与ORH组比较术中出血量少、术后并发症发生率低、住院时间短,差异有统计学意义(P<0.05).LRH组与ORH组比较,LRH组的手术时间比ORH组长,差异有统计学意义(P<0.05).LRH组与ORH组的术后1年生存率、术后2年生存率组间比较差异均无统计学意义(P>0.05).结论 LRH在肝脏手术治疗中是安全、可行的,虽然LRH的手术时间要长于ORH组,但与ORH比较,LRH具有创伤小、术中出血量较少、术后并发症发生率低、住院时间短等特点,且在术后1年生存率、术后2年生存率方面与ORH比较,差异无统计学意义(P>0.05).由于纳入研究数量和质量存在局限性,上述结论仍需开展大样本、高质量的RCT研究进一步验证.

Objective To systematically evaluate the effectiveness and safety of laparoscopic right hepatectomy(LRH) versus open right hepatectomy(ORH) for hepatic malignancy. Methods Databases including PubMed,EMbase,the Cochrane Library,CBM,CNKI and VANFUN were searched to collect the randomized controlled trails(RCTs) and non-RCTs about LRH versus ORH. We reviewed the literature, extracted the data, and evaluated the quality using the Cochrane systematic review method. The statistical analysis was performed using Review Manager version 5.3. Continuous variables were calculated by the mean differences(MD) with 95% confidence interval(CI), whereas dichotomous variables were calculated by odds ratio(OR) with 95%CI. Results A total of 4 case-control studies(There was not RCTs) were included. There were 308 patients, 98 in the LRH group and 210 in the ORH group. Meta-analysis showed that the LRH group had less intraoperative blood loss, lower postoperative complications, and shorter postoperative hospital stay than the ORH group(P<0.05). LRH group had a longer operative time than the ORH group(P<0.05). There was no significant difference in postoperative 1-year survival rate, and postoperative 2-year survival rate between the LRH group and the ORH group(P>0.05). Conclusion LRH is safe and feasible in hepatectomy. Compared with ORH, although LRH needed longer operative time, LRH is characterized by less trauma, less intraoperative blood loss, lower postoperative complications, and shorter hospital stay. Postoperative 1-year survival rate, and postoperative 2-year survival rate were not significantly different from ORH. Due to limitations in the quantity and quality of the studies, the above conclusions still need to be further validated by large samples and high-quality RCTs.