腹腔镜与开腹胆囊癌根治术治疗早期胆囊癌疗效的Meta分析

Efficacy of laparoscopic versus open radical cholecystectomy for early gallbladder cancer:a Meta-analysis

目的:比较早期胆囊癌行腹腔镜与开腹胆囊癌根治术的临床疗效。方法:计算机检索英文及中文数据库关于腹腔镜与开腹手术治疗早期胆囊癌的对照研究,检索截止时间为2019年12月。对纳入的文献进行质量评价与数据提取后,采用RevMan 5.3软件进行Meta分析。结果:共纳入8项研究、462例患者,其中腹腔镜组214例,开腹组248例。Meta分析结果显示,与开腹组相比,腹腔镜组术中出血量少(WMD=-113.44,95%CI=-163.58~-63.30,P<0.00001),并发症发生率低(OR=0.51,95%CI=0.27~0.96,P=0.04)、术后住院时间短(WMD=-5.03,95%CI=-6.61~-3.46,P<0.00001)、术后局部复发率低(OR=0.42,95%CI=0.20~0.87,P=0.02),两组手术时间(WMD=-22.39,95%CI=-52.02~7.24,P=0.14)、淋巴结清扫数量(WMD=-0.86,95%CI=-2.34~0.62,P=0.25)差异无统计学意义。结论:相较开腹胆囊癌根治术,腹腔镜胆囊癌根治术治疗早期胆囊癌是安全、可行的,在减少术中出血、缩短术后住院时间、降低术后并发症发生率与术后局部复发率等方面具有优势。

Objective:To compare the clinical efficacy of laparoscopic radical cholecystectomy(LRC)and open radical cholecystectomy(ORC)in the treatment of early gallbladder cancer.Methods:The controlled studies comparing LRC and ORC in treatment of early gallbladder cancer published in English and Chinese were searched through online databases.The retrieval time was up to Dec.2019.After the quality evaluation and data extraction of the included studies,Meta-analysis was conducted by using RevMan 5.3 software.Results:Eight studies were finally included involving 462 patients,with 214 cases in LRC group and 248 in ORC group.The results of Meta-analysis showed that compared with ORC group,in LRC group the intraoperative blood loss was reduced(WMD=-113.44,95%CI=-163.58~-63.30,P<0.00001),incidence of complications was decreased(OR=0.51,95%CI=0.27~0.96,P=0.04)and length of postoperative hospital stay was shortened(WMD=-5.03,95%CI=-6.61~-3.46,P<0.00001),postoperative local recurrence rate was lower(OR=0.42,95%CI=0.20~0.87,P=0.02),no significant differences were noted with regard to the operation time(WMD=-22.39,95%CI=-52.02~7.24,P=0.14)and number of lymph node dissection(WMD=-0.86,95%CI=-2.34~0.62,P=0.25).Conclusions:Compared with ORC,LRC is safe and feasible in the treatment of early gallbladder cancer,it has the advantage of reducing intraoperative bleeding,shortening postoperative hospital stay and reducing the incidence of postoperative complications and postoperative local recurrence rate.