对ALPPS手术实用性与安全性的系统回顾和Meta分析

目的 通过联合肝脏分隔和门静脉结扎的二步肝切除术(ALPPS)和传统二阶段手术(TSH)进行系统回顾和Meta分析,综合评价这两种手术的实用性和安全性.方法 运用计算机检索MEDLINE、EMBASE等数据库,查找2013-2016年关于ALPPS手术和TSH手术临床相关文献资料.运用Revmen 5.0软件进行统计学分析,计量资料采用均数差(MD)作为评价分析统计量;计数资料采用比值比(OR)作为评价分析统计量,各效应量均以95％可信区间(CI)表示.异质性检验采用x2检验(检验标准为P ＜0.05),无异质性采用固定效应模型,在异质性较高的情况下,则采用随机效应模型.结果 经过筛查,4项研究共312例手术符合纳入标准.将两组手术进行Meta分析,研究结果显示,ALPPS组FLR增长率明显高于TSH组(MD =24.78;95％ CI:0.63 ～48.94;P=0.04);且ALPPS组FLR增长时间较TSH组显著缩短(MD=-26.55;95％CI:-37.13～-15.97;P＜0.05);ALPPS组术后严重并发症(≥Ⅲb)的发病率要高于TSH组(OR=2.47;95％CI:1.14～5.36;P =0.02);而ALPPS组和TSH组术后病死率没有明显区别(OR=2.43;95％ CI:0.94～6.31;P =0.07).结论 ALPPS手术较TSH手术可以更好地在较短时间内使预留残肝体积增长到安全切除范围,且两组术后病死率无明显差别,但ALPPS较TSH术后严重并发症(≥Ⅲb)的发病率仍然很高.

Systematic review and Meta-analysis of feasibility and safety of associating liver partition and portal vein ligation for staged hepatectomy

Objective To assess the feasibility and safety between ALPPS and two-stage hepatectomy (TSH).Methods An electronic search was performed of the MEDLINE,EMBASE using subject heading to identify nearly three-years articles published that related to this topic.Pooled odds ratio was calculated for binary data and mean differences for continuous outcomes,using fixed-effects and random-effects models for meta-analysis.Results Four studies involving a total of 312 patients were used in the analysis.We found that ALPPS produced a higher increase rate of FLR than TSH (MD =24.78;95％CI:0.63 to 48.94;P =0.04).Comparing with TSH,ALPPS produced a shorter FLR growth time (MD =-26.55;95％ CI:-37.13 to -15.97,P ＜ 0.05).There was no statistical significance in overall mortality (OR =2.43;95 ％ CI:0.94 to 6.31;P =0.07),while ALPPS produced a more severe complication rate (≥ Ⅲ b) than TSH (OR =2.47;95 ％ CI:1.14 to 5.36;P =0.02).Conclusions It was better to make the FLR increasing to safe resection for ALPPS than TSH in a short period of time.There was no statistical significance in overall complication and mortality between ALPPS and TSH,but ALPPS produced more severe complication rate (≥ Ⅲb) than TSH.