ALPPS与传统分步肝切除术的Meta分析

Meta-analysis of ALPPS and traditional stepwise hepatectomy

目的系统评价肝脏分隔结合门静脉结扎的分步肝切除(ALPPS)与传统分步肝切除术如门静脉栓塞(PVE)和二步肝切除(TSH)的围术期疗效差异。方法通过计算机检索知网、万方、PubMed、Cochrane、Embase、中国生物医学文献数据库,检索时限为2011年1月1日至2019年12月31日,收集国内外ALPPS与PVE/TSH的临床对比研究,采用RevMan 5.3软件进行Meta分析。结果共纳入8篇研究,共涉及732例患者。Meta分析结果显示,ALPPS与PVE/TSH在FLR增长率、二步手术完成率及R0切除率方面比较,差异均有统计学意义(P<0.05)。ALPPS的围术期并发症总发生率高于PVE/TSH,但差异无统计学意义(P>0.05)。ALPPS的90 d死亡率略高于PVE/TSH,但差异无统计学意义(P>0.05)。结论ALPPS的FLR增长率、二步手术完成率和R0切除率均高于PVE/TSH,在把握适应证的前提下,ALPPS有效可行。

Objective To systematically evaluate the difference in perioperative efficacy between associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)and traditional stepwise hepatectomy,such as portal vein embolization(PVE)and two-step hepatectomy(TSH).Methods A computer search was conducted on CNKI,Wanfang,PubMed,Cochrane,Embase and Chinese Biomedical Literature Database to collect the data on comparative clinical studies of ALPPS and PVE/TSH domestic and overseas from January 1,2011 to December 31,2019.The RevMan 5.3 software was used for Meta-analysis.Results A total of 8 studies were included,involving 732 patients.Meta-analysis results showed that there were statistically significant differences in FLR growth rate,two-step surgery completion rate and R0 resection rate between ALPPS and PVE/TSH(P<0.05).ALPPS had a higher incidence of total perioperative complications than PVE/TSH,but the difference was not statistically significant(P>0.05).The 90-day mortality was slightly higher in the ALPPS group than in the PVE/TSH group,but the difference was not statistically significant(P>0.05).Conclusion ALPPS has a better FLR growth rate,higher two-step surgery completion rate and R0 resection rate than PVE/TSH.Under the premise of grasping the indications,ALPPS is effective and feasible.