半肝阻断法和全肝阻断法在原发性肝癌肝切除术中应用效果比较的Meta分析

目的比较普林格尔法(Pringle’s measure,PM)和半肝血管流入阻断法(HVO)在原发性肝癌肝切除术中的应用效果。方法计算机检索中、英文数据库中关于HVO和PM治疗原发性肝癌的对照研究,查找时间为数据库建立至2020年6月。对纳入的研究进行质量评价和数据提取后,采用RevMan5.3软件进行Meta分析。结果共纳入10项研究,合计1272例患者。HVO组术后第1、3天ALT水平低于PM组[均数差(MD)=-172.71,95%CI:-289.26~-56.16,P=0.004;MD=-130.35,95%CI:-221.25~-39.45,P=0.005],术后第3天AST水平低于PM组(MD=-84.56,95%CI:-166.47~-2.65,P=0.04),术后第1、3天Alb水平高于PM组(MD=1.31,95%CI:0.06~2.56,P=0.04;MD=1.81,95%CI:0.27~3.35,P=0.02),手术时间较PM组长(MD=8.95,95%CI:4.30~13.60;P<0.01)。结论HVO是一种安全有效的血流阻断方法,与PM相比能有效减轻肝损伤。但外科医生还应根据个人经验、患者病情以及术中具体情况选择适合患者的阻断方法。

Effect of hemihepatic vascular exclusion versus total hepatic vascular exclusion in hepatectomy for primary liver cancer:A Meta-analysis

Objective To systematically evaluate the effect of Pringle’s measure(PM)versus hemihepatic vascular occlusion(HVO)in hepatectomy for primary liver cancer.Methods Related Chinese and English databases were searched for control studies on HVI versus PM in the treatment of primary liver cancer published up to June 2020.After quality evaluation and data extraction of the included studies,RevMan5.3 software was used for the meta-analysis.Results A total of 10 studies were included in the Meta-analysis,with 1272 patients in total.On days 1 and 3 after surgery,the HVO group had a significantly lower level of alanine aminotransferase than the PM group(day 1:mean difference[MD]=-172.71,95%confidence interval[CI]:-289.26 to-56.16,P=0.004;day 3:MD=-130.35,95%CI:-221.25 to-39.45,P=0.005).On day 3 after surgery,the HVO group had a significantly lower level of aspartate aminotransferase than the PM group(MD=-84.56,95%CI:-166.47 to-2.65,P=0.04),and on days 1 and 3 after surgery,the HVO group had a significantly higher level of albumin than the PM group(day 1:MD=1.31,95%CI:0.06-2.56,P=0.04;day 3:MD=1.81,95%CI:0.27-3.35,P=0.02).The HVO group had a significantly longer time of operation than the PM group(MD=8.95,95%CI:4.30-13.60,P<0.01).Conclusion HVO is a safe and effective method for vascular occlusion,and compared with PM,it can effectively alleviate liver injury.However,surgeons should select a suitable method for occlusion based on their own personal experience,patients’conditions,and specific situation during surgery.