腹腔镜肝切除与射频消融治疗肝细胞癌疗效的荟萃分析

Radiofrequency ablation versus laparoscopic hepatectomy for hepatocellular carcinoma:a Meta-analysis

目的比较腹腔镜肝切除术(LH)与射频消融(RFA)治疗肝细胞癌的疗效与安全性。方法在PubMed、Web of Science、Embase、维普、万方、中国知网等电子数据库检索腹腔镜肝切除与射频消融治疗肝细胞癌的相关文献。检索日期为建库至2021年6月7日。根据纳入排除标准,由2位作者分别进行数据提取,并使用Revman 5.3软件对数据进行荟萃分析,比较LH组与RFA组患者的手术时间、出血量、住院时间、总并发症、总生存时间及无病生存期等的差异。结果共纳入32篇文献合计3690例患者,其中LH组1708例,RFA组1982例。荟萃分析显示,与LH组相比,RFA组的手术时间短(MD=-86.41,95%CI:-116.21~-56.60)、出血量少(MD=-213.22,95%CI:-273.43~-153.00)、住院时间短(MD=-3.23,95%CI:-4.13~-2.32)、并发症发生率低(OR=0.33,95%CI:0.26~0.43),但局部复发率高(OR=1.83,95%CI:1.38~2.41),差异有统计学意义(均P<0.05)。LH组5年生存率优于RFA组,差异具有统计学意义(OR=0.68,95%CI:0.51~0.90,P=0.008)。结论与RFA相比,LH术后肝细胞癌患者局部复发率低,远期生存率高。

Objective To compare the effectiveness and safety of laparoscopic hepatectomy(LH)versus radiofrequency ablation(RFA)in treatment of hepatocellular carcinoma(HCC).Methods The medical literatures on LH and RFA for HCC were searched in PubMed,Web of Science,Embase,VIP,Wanfang,CNKI and other electronic databases.The retrieval date was from database construction to June 7,2021.According to the inclusion and exclusion criteria,studies were extracted by two authors,and Revman 5.3 software was used to conduct a meta-analysis to compare differences in operation time,blood loss,length of hospital stay,total complications,overall survival and disease-free survival outcomes between the LH group and the RFA group.Results Of 3690 patients who were included in 32 studies,there were 1708 patients in the LH group and 1982 patients in the RFA group.Meta-analysis showed that compared with the LH group,the RFA group had significantly shorter surgical duration(MD=-86.41,95%CI:-116.21--56.60),less blood loss(MD=-213.22,95%CI:-273.43--153.00),shorter hospital stay(MD=-3.23,95%CI:-4.13--2.32),and lower incidence of complications(OR=0.33,95%CI:0.26-0.43).However,local recurrence rate was significantly higher(OR=1.83,95%CI:1.38-2.41).(All P<0.05).The 5-year survival rate of the LH group was significantly better than the RFA group(OR=0.68,95%CI:0.51-0.90,P=0.008).Conclusion LH provided better overall survival outcomes and lower local recurrence rates than RFA in HCC patients.