腹腔镜与开腹左半肝切除术治疗肝内胆管结石安全性和疗效比较Meta分析

Comparison of safety and efficacy between laparoscopic and open left hepatectomy in treatment of hepatolithiasis:a Meta-analysis

目的系统比较腹腔镜左半肝切除术(LLH)和开腹左半肝切除术(OLH)治疗肝内胆管结石的安全性和疗效。方法通过计算机检索PubMed、EMBASE、中国知网、万方数据库和维普数据库中2010年1月至2020年1月左半肝切除术治疗肝内胆管结石的文献。提取手术时间、术中出血量、住院时间、术后首次排气、术后下床时间、术后并发症等指标。采用Review Manager 5.3软件进行Meta分析。结果共纳入符合标准的文献11篇,均为临床随机对照试验研究,共773例,其中LLH组387例,OLH组386例。Meta分析显示,与OLH相比,LLH可明显缩短住院时间、术后排气时间和术后早期下床时间(MD=-3.27,-0.98,-1.20;P<0.05),降低术后并发症发生率和术后切口感染发生率(OR=0.39,0.31;P<0.05)。结论与OLH相比,LLH治疗肝内胆管结石具有住院时间短、术后并发症少和术后恢复快的优势,可加速患者术后康复。

Objective To systematically compare the safety and efficacy between laparoscopic left hepatectomy(LLH)and open left hepatectomy(OLH)in the treatment of hepatolithiasis.Methods Literature related to left hepatectomy for hepatolithiasis between January 2010 to January 2020 were retrieved in database of PubMed,EMBASE,CNKI,Wanfang and VIP.Clinical parameters including operation time,intraoperative blood loss,length of hospital stay,time to initial anal exhaust,time to out-of-bed activity and postoperative complications were collected.Meta-analysis was conducted by using Review Manager 5.3 software.Results A total of 11 eligible articles were included,all of which were studies of clinical randomized controlled trials.Among 773 patients,387 cases were allocated in the LLH group and 386 cases in the OLH group.Meta-analysis demonstrated that compared with OLH,LLH could significantly shorten the length of hospital stay,time to initial anal exhaust and time to out-of-bed activity(MD=-3.27,-0.98,-1.20;P<0.05),and remarkably lowered the incidence of postoperative complications and incisional infection(OR=0.39,0.31;P<0.05).Conclusions Compared with OLH,LLH has multiple advantages of shorter length of hospital stay,less postoperative complications and faster postoperative recovery,which can accelerate postoperative rehabilitation of patients.