腹腔镜与开腹肝切除术治疗复发性肝细胞癌的meta分析

Laparoscopic and open hepatectomy on recurrent hepatocellular carcinoma:a meta-analysis

目的通过meta分析评估腹腔镜肝切除术和开腹肝切除术治疗复发性肝细胞癌的临床疗效。方法在Cochrane Library、PubMed、Embase、Web of Science和CNKI数据库中搜索截至2021年3月31日发表的符合条件的文献,使用Review Manager 5.3软件进行统计分析。结果共纳入8篇文献,合计655例患者(腹腔镜组313例和开腹组342例)。与开腹组相比,腹腔镜组在以下方面有更好的效果:手术时间[标准均方差(SMD)=-0.71,95%可信区间(95%CI)(-0.91,-0.52),P<0.00001]、术中出血量[SMD=-1.62,95%CI(-1.99,-1.25),P<0.00001]、肛门首次排气时间[SMD=-0.89,95%CI(-1.35,-0.43),P=0.0002]、术后下床活动时间[SMD=-1.44,95%CI(-2.08,-0.79),P<0.0001]、术后住院时间[SMD=-1.54,95%CI(-2.18,-0.89),P<0.00001]。结论腹腔镜切除术治疗复发性肝细胞癌是可行的,且腹腔镜肝切除术比开腹肝切除术治疗复发性肝细胞癌安全性更高。推荐将腹腔镜切除术作为复发性肝细胞癌患者的首选手术方式。

Objective To evaluate the clinical efficacy of complete laparoscopic hepatectomy(LH)and open hepatectomy(OH)on recurrent hepatocellular carcinoma(rHCC)by meta-analysis.Methods The Cochrane Library,PubMed,Embase,Web of Science and CNKI Databases were searched for eligible literature published up to 31st March 2021.Statistical analysis was performed with Review Manager 5.3 software.Results A total of 655(313 in the LH group and 342 in the OH group)patients included in eight articles were eligible for this study.Compared with the OH group,the LH group had significant better results in the following aspects:operative duration[standard mean deviation(SMD)=-0.71,95%confidence interval(95%CI)(-0.91,-0.52),P<0.00001],intraoperative bleeding[SMD=-1.62,95%CI(-1.99,-1.25),P<0.00001],first passage of gas by anus[SMD=-0.89,95%CI(-1.35,-0.43),P=0.0002],postoperative activity time(days)[SMD=-1.44,95%CI(-2.08,-0.79),P<0.0001],and postoperative hospital stay time[SMD=-1.54,95%CI(-2.18,-0.89),P<0.00001].Conclusion The LH is feasible for rHCC,and the LH is safer than the OH.Therefore,it is recommended to be regarded as the preferred therapy of patients with rHCC.