腹腔镜肝后上段肿物对比肝前下段肿物切除术安全性与有效性的荟萃分析

A meta-analysis of the safety and effectiveness of laparoscopic liver resection for lesions located in posterosuperior versus anterolateral segments

目的:通过荟萃分析对腹腔镜肝后上段肿物与肝前下段肿物切除术的安全性及有效性进行全面评估及对比。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2001年3月至2021年3月腹腔镜肝后上段肿物与肝前下段肿物切除术对比文献,纳入符合文献质量评价标准的文献,提取术中结局指标、术后短期结局指标及术后长期结局指标进行荟萃分析。结果:与肝前下段组患者相比,肝后上段组患者手术时间延长,中转开腹率增多,且差异均有统计学意义(P<0.0001)。而两组患者术中出血量、术中输血率、手术切缘距离、肝门阻断时间、术后住院时间、术后并发症发生率等差异均无统计学差异(P>0.05)。对于恶性肿瘤患者,腹腔镜切除术后患者无瘤生存期及总生存时间与肿瘤部位无关(P>0.05)。结论:腹腔镜肝后上段肿物切除术虽然难度较大,但是一种安全、有效、可行的微创手术方式,在腹腔镜技术成熟后开展可能对患者更有利。

Objective:To comprehensively evaluate and compare the safety and effectiveness of laparoscopic liver resection(LLR)for posterosuperior lesions versus anterolateral lesions.Methods:A comprehensive search of literature during March 2001 and March 2021 on LLR for posterosuperior lesions versus anterolateral lesions was conducted.Literatures that met the criteria were included.Meta-analysis was performed on intraoperative outcome indicators,short-term postoperative outcome indicators and long-term outcome indicators.Results:Compared with LLR for anterolateral lesions,the operation time was significantly longer,and conversion rate was significantly increased(P<0.0001)in LLR for posterosuperior lesions.There were no significant difference in intraoperative blood loss,intraoperative blood transfusion rate,surgical margin distance,pringle maneuver duration,postoperative hospital stay,postoperative complications(P>0.05).Among them,for patients with malignant tumors,there was no relationship between postoperative tumor-free survival as well as overall survival and tumor location(P>0.05).Conclusion:Although LLR for lesions located in posterosuperior segments is difficult,it is a safe,effective and feasible minimally invasive surgical method that may be more beneficial to patients after the laparoscopic technique is mature.