腹腔镜与开腹右半肝切除术治疗肝肿瘤疗效比较的Meta分析

目的系统评价腹腔镜右半肝切除术(LRH)与开腹右半肝切除术(ORH)治疗肝肿瘤的手术有效性及安全性。方法计算机系统检索PubMed、Embase、the Cochrane Library、CNKI和万方数据库,收集LRH与ORH治疗肝肿瘤疗效比较的文献。按Cochrane系统评价方法筛选随机或非随机同期试验、提取资料并评价质量后,使用RevMan 5. 3进行统计分析。连续变量通过均值差(MD)及其95%CI计算,二分类变量通过比值比(OR)及其95%CI计算。结果共纳入8篇病例对照研究(无随机对照试验),共591例患者,LRH组219例,ORH组372例。Meta分析结果显示,与ORH组相比,LRH组术中出血量减少、术后并发症发生率降低、住院时间缩短(P <0. 05,P <0. 01),手术时间延长,差异有统计学意义(P <0. 05)。对肝恶性肿瘤患者随访,LRH组与ORH组的术后1年生存率、术后2年生存率组间差异均无统计学意义(P均> 0. 05)。结论 LRH在肝脏手术治疗中是安全、可行的,虽然LRH的手术时间长于ORH组,但与ORH相比,LRH具有创伤小、术中出血量较少、术后并发症发生率低、住院时间短等特点,且在术后1年生存率、术后2年生存率方面与ORH组无明显差异。由于纳入研究数量和质量存在局限性,上述结论仍需大样本、高质量的临床随机对照试验进一步验证。

Comparison of efficacy of laparoscopic and open right hepatectomy for liver tumors: a meta-analysis

Objective To systematically evaluate the efficacy and safety of laparoscopic right hepatectomy( LRH) and open right hepatectomy( ORH) for the treatment of liver tumors. Methods The PubMed,Embase,the Cochrane Library,CNKI,and Wanfang databases were searched by computer,and randomized or non-randomized ontrolled trials comparing the efficacy of LRH with ORH in the trecatment of liver tumors were collected. After screening the literature,extracting the data and evaluating the quality according to the Cochrane systematic review method,statistical analysis was performed using RevMan 5. 3. Continuous variables were calculated by mean difference( MD) and 95% confidence interval( CI),while binary variables were calculated by odds ratio( OR) and 95% CI. Results A total of 8 case-control studies,but no randomized controlled trials( RCT) were included,with a total of 591 patients( 219 in the LRH group and 372 in the ORH group).Meta-analysis showed: compared with the ORH group,the LRH group had less intraoperative blood loss,lower incidence of postoperative complications,and shorter hospital stay( P < 0. 05,P < 0. 01);the operation time of LRH group was longer than that of ORH group( P < 0. 05). During follow-up of patients with liver malignant tumors,there was no significant difference in the 1-year survival rate and 2-year survival rate between the LRH group and the ORH group( all P > 0. 05).Conclusions LRH is safe and feasible in liver surgery. Although the operation time of LRH is longer than that of ORH group,but LRH has the characteristics of less trauma,less intraoperative blood loss,lower incidence of postoperative complications and shorter hospital stay,and has no significant difference with ORH in 1-year survival rate and 2-year survival rate. Due to limitations in the number and quality of included studies,the above conclusions need to be further validated with large sample and high quality clinical RCTs.