腹腔镜手术与开腹手术在肝细胞癌中应用的Meta分析

目的评价腹腔镜手术与开腹手术治疗肝细胞癌的疗效及安全性。方法应用循证医学的系统评价方法,对2002年1月至2012年12月在国内外医学期刊发表的有关围术期腹腔镜手术与开腹手术在肝细胞癌中的临床病例对照研究进行质量评价。结果纳入19个病例对照研究的疗效,纳入文献的总体方法学质量较高。Meta分析结果显示,与开腹手术相比较,腹腔镜肝切除术未能显著缩短手术时间(SMD=-0.39,95%CI-0.94^-0.15,P=0.15),减少术中出血量(SMD=-0.76,95%CI-0.92-0.15,P=0.15),减少术中出血量(SMD=-0.76,95%CI-0.92^-0.59,P=0.03),缩短住院时间(SMD=-0.86,95%CI-1.31-0.59,P=0.03),缩短住院时间(SMD=-0.86,95%CI-1.31^-0.98,P<0.00001),减少肛门排气时间(SMD=-0.87,95%CI-1.18-0.98,P<0.00001),减少肛门排气时间(SMD=-0.87,95%CI-1.18^-0.56,P<0.00001)。结论腹腔镜手术能够最大限度地降低手术对患者内环境的影响,患者的出院时间、肛门排气时间均显著少于开腹切除组。

Meta-analysis of Laparoscopic Surgery and Open Surgery Application in Hepatocellular Carcinoma

Objective To evaluate the efficacy and saiety of laparoscopic operation and laparotomy in the treatment of hepatocellular carcinoma. Methods Using evaluation methods of evidence-based medicine, quality evaluation of case control studies of the perioperative laparoscopic operation and open operation for hepatocellular carcinoma published in domestic and foreign medical journals during Jan. 2002 and Dec. 2012 was done. Results Altogether therapeutic effect of 19 case control studies were included ,the overall methodology quality of literature included was high. Meta-analysis results showed that, compared with open operation, laparoscopic liver resection failed to significantly shorten the operation time, the results showed no significant difference between the two groups （SMD = -0.39,95 % CI -O. 94- -0.15,P = 0.15 ） , but succeeded in reducing the amount of bleeding, with a significant difference between the two groups （ SMD = - 0. 76, 95% CI - 0. 92- - 0.59, P = 0.03 ）, and shortening the time of hospitalization, with significant difference between the two groups （ SMD = - 0.86,95 % CI - 1.31- - 0.98, P 〈 0. 00001 ） , and reducing anal exhaust time, with significant difference （ SMD = - 0.87,95 % CI - 1.18- - 0.56, P 〈 0. 00001 ）. Conclusion Laparoscopic operation can reduce the operation effect on internal environment in patients maximally, the discharge time, anal exhaust time are significantly less than the open surgery group.