腹腔镜肝切除与开腹肝切除治疗原发性肝癌安全性及疗效的Meta分析

目的 通过Meta分析的方式评估腹腔镜肝切除(LH)与传统开腹肝切除(OH)治疗原发性肝癌围手术期的安全性及疗效.方法 计算机检索PubMed、EMBASE、Cochrane Library、Medline等数据库中2016年4月之前发表的关于比较腹腔镜肝切除和开腹肝切除治疗原发性肝癌的随机对照研究或回顾性对照研究,同时根据以上检索所得文献的参考文献进行扩大检索.采用Cochrane协作网提供的RevMan 5.3统计软件进行Meta分析,分析的主要内容包括术中出血量、手术时间、术后整体并发症、围手术期死亡率、住院时间.结果 共纳入10项符合标准的研究,共计1113例患者.Meta分析结果显示,LH与OH相比,围手术期死亡率差异无统计学意义(OR=0.67,95%CI=0.28~1.62,P=0.38),而LH在手术时间(MD=-16.65,95%CI=-26.59~-6.71,P=0.001)、术中出血量(MD=-171.83,95%CI=-305.50~-38.16,P=0.01)、术后总体并发症发生率(OR=0.47,95%CI=0.34~0.65,P<0.01)以及住院时间(MD=-3.80,95%CI=-5.63~-1.97,P<0.01)方面较OH有显著优势.结论 通过Meta分析发现,LH应用于原发性肝癌治疗的安全性与OH一致,而在减少手术时间、术中出血、术后并发症及住院时间方面具有一定的优势.

Comparison of laparoscopic hepatectomy with open hepatectomy in the treatment of primary hepatocarcinoma during perioperative period: a meta-analysis

Objective To evaluate surgical safety and effectiveness of laparoscopic hepatectomy ( LH) and traditional open hepatectomy ( OH) in the treatment of primary hepatocarcinoma during perioperative period by meta-analysis.Methods The Pubmed, EMBASE, Cochrane Library and Medline database were retrieved for randomized controlled studies and retrospective controlled studies on the comparison of laparoscopic hepatectomy and traditional open hepatectomy for hepatocellular carcinoma published from the incep-tion to April 2016, and extended information retrieval was performed in accordance with the retrieved documents.Meta-analysis was performed by using Cochrane Review Manager Software (Version 5.3).Indicators for analysis included surgical blood loss, surgical time, postoperative complications, perioperative mortality, as well as length of hospital stay.Results A total of 10 studies conforming to the required standards were included in the study, involving a total of 1113 patients.Meta-analysis indicated that no significant differences could be seen in perioperative mortality, when comparisons were made between LH and OH ( OR=0.67, 95%CI=0.28~1.62, P=0.38).However, as compared with OH, LH had a significant advantage in surgical time (MD=-16.65, 95% CI=-26.59~-6.71, P=0.001), surgical blood loss (MD=-171.83, 95%CI=-305.50~-38.16, P=0.01), total postopera-tive complications (OR=0.47, 95%CI=0.34~0.65, P<0.05), and length of hospital stay (MD=-3.80, 95% CI=-5.63~-1.97, P<0.05).Conclusion Meta-analysis revealed that LH was equivalent to OH in surgical safety in the treatment of primary hep-atocarcinoma, however, it was superior to OH in surgical time, surgical blood loss, perioperative mortality and length of hospital stay.