肝癌切除术后胸腔积液危险因素的Meta分析

Meta-analysis of risk factors for pleural effusion after hepatectomy for liver cancer

背景与目的:全球范围内肝癌发病率呈现上升趋势,严重影响人类健康。肝切除术通常作为肝癌首选治疗方法,但术后并发症较高,远期疗效待提高。胸腔积液是肝切除术后常见并发症,研究发现血清白蛋白水平、饮酒、右肝切除等与肝切除术后胸腔积液的发生关系密切,但目前尚无统一定论。本研究旨在通过Meta分析的方法探讨肝癌患者肝切除术后并发胸腔积液的危险因素,为降低肝切除术后胸腔积液发生率提供依据。方法:检索多个国内外数据库,收集建库至2020年10月公开发表的关于肝癌患者肝切除术后胸腔积液影响因素的文献,按纳入标准和排除标准进行文献筛选,制定数据提取表提取数据后,应用Rev Man5.3软件对各项指标进行Meta分析。结果:共纳入13篇病例对照研究文献,合计5 422例患者,Meta分析显示,肝癌患者肝切除术后胸腔积液的主要危险因素有高龄(MD=5.03,95%CI=1.858.21)、术前血清白蛋白低(OR=-1.28,95%CI=-2.14-0.42)、有饮酒史(OR=1.46,95%CI=1.032.06)、合并慢性阻塞性肺疾病(OR=3.15,95%CI=1.158.59)、乙型肝炎病毒和丙型肝炎病毒感染(OR=0.98,95%CI=0.721.34;OR=2.17,95%CI=1.184.00)、腹水(MD=7.13,95%CI=3.5314.40)、肿瘤直径大(MD=1.30,95%CI=0.272.33)、肝门长时间阻断(MD=3.24,95%CI=1.654.83)、术中出血量大(MD=482.99,95%CI=183.24782.74)、手术时间长(MD=67.14,95%CI=47.4986.79)、右肝肿瘤切除(MD=10.29,95%CI=4.6022.99)、术后总胆红素(TBIL)水平高(MD=19.83, 95%CI=6.1733.49)、术后凝血酶原时间长(MD=2.15, 95%CI=0.194.10)、术后白蛋白低(MD=-4.06,95%CI=-7.07-1.06)。不确定因素有术前TBIL、肝硬化、糖尿病。结论:本研究确定14项肝切除术后并发胸腔积液的危险因素,针对这些危险因素采取相应预防措施,有利于降低肝切除术后胸腔积液发生。本研究结果仍有待未来大样本、更严谨的多中心随机对照试验来验证。

Background and Aims: The incidence of liver cancer is on the rise worldwide, which seriously affects human health. Hepatectomy is usually the first choice for the treatment of liver cancer, but its incidence of postoperative complications remains high and long-term efficacy needs to be improved. Pleural effusion is a common complication after hepatectomy. Studies have found that serum albumin level,alcohol consumption, right liver resection and other factors are closely related to the occurrence of pleural effusion after hepatectomy, but there is no unified conclusion at present. This study was conducted to investigate the risk factors for pleural effusion in patients with liver cancer after hepatectomy by means of Meta analysis, so as to provide a framework for reducing the incidence of pleural effusion after hepatectomy.Methods: The studies concerning the influencing factors for pleural effusion in patients with liver cancer after hepatectomy published from the inception of databases to October 2020 were searched in several national and international databases. The literature was screened according to the inclusion and exclusion criteria, and the data extraction table was developed. Meta-analysis of each variable was performed using Rev Man 5.3 software.Results: A total of 13 case-control studies were included, involving 5 422 patients. Results of Metaanalysis showed that the main risk factors for pleural effusion after hepatectomy in patients with liver cancer included advanced age(MD=5.03, 95% CI=1.85-8.21), low serum albumin before surgery(OR=-1.28, 95% CI=-2.14-0.42), history of alcohol consumption(OR=1.46, 95% CI=1.03-2.06),concomitant chronic obstructive pulmonary disease(OR=3.15, 95% CI=1.15-8.59), hepatitis B virus and hepatitis C virus infection(OR=0.98, 95% CI=0.72-1.34;OR=2.17, 95% CI=1.18-4.00), ascites(MD=7.13, 95% CI=3.53-14.40), large tumor diameter(MD=1.30, 95% CI=0.27-2.33), prolonged hilar occlusion(MD=3.24, 95% CI=1.65-4.83), large intraoperative blood loss(MD=482.99, 95% CI=183.24-782.74), long operative time(MD=67.14, 95% CI=47.49-86.79), right liver tumor resection(MD=10.29,95% CI=4.60-22.99), high postoperative total bilirubin(TBIL) level(MD=19.83, 95% CI=6.17-33.49),long prothrombin time after operation(MD=2.15, 95% CI=0.19-4.10), and low postoperative albumin(MD=-4.06, 95% CI=-7.07-1.06). The uncertain factors included preoperative TBIL, cirrhosis, and diabetes mellitus.Conclusion: A total of 14 risk factors for pleural effusion after hepatectomy are identified in this study,and corresponding preventive measures against these risk factors are helpful for reducing the occurrence of pleural effusion after hepatectomy. The conclusion still needs to be verified by larger sample size and more rigorous multicenter randomized controlled trials in the future.