腹腔镜与开腹肝门部胆管癌根治术疗效比较的Meta分析

目的:系统评价腹腔镜肝门部胆管癌根治术(laparoscopic radical resection for hilar cholangiocarcinoma, LRRHC)与开腹肝门部胆管癌根治术(open radical resection for hilar cholangiocarcinoma, ORRHC)两种手术方式的临床疗效。方法:以laparoscopy、laparoscopic、laparotomy、open surgery、bile duct neoplasms、hilar cholangiocarcinoma、腹腔镜手术、开腹手术、胆管癌、肝门部胆管癌为检索词，检索PubMed、Embase、the Cochrane Library、CBM、CNKI、VANFUN数据库。检索时间为1960年01月至2020年12月。根据Cochrane系统评价原则，由两名研究者独立筛选文献并提取数据，进行质量评价后使用Review Manager 5.3版进行统计分析。计量资料采用均数差(MD)及其95%可信区间(95%CI)表示，计数资料采用比值比(OR)及其95%CI表示。采...

Laparoscopic versus open radical resection for hilar cholangiocarcinoma:A Meta-analysis

Objective:To systematically evaluate the clinic effect of laparoscopic versus open radical resection for hilar cholangiocarcinoma.Methods:Databases including PubMed,EMbase,the Cochrane Library,CBM,CNKI and VANFUN were searched for from January 1960 to December 2020 with the key words including"laparoscopy,laparoscopic,laparotomy,open surgery,bile duct neoplasms,hilar cholangiocarcinoma".Reviewed the literature,extracted the data,and evaluated the quality using the Cochrane systematic review method.The statistical analysis was performed using Review Manager version 5.3.Continuous variables were calculated by the mean differences(MD)with 95%confidence interval(CI),whereas dichotomous variables were calculated by odds ratio(OR)with 95%CI.The heterogeneitv of the studies included was analyzed using the I² test.Funnel plotwas used to testpotential publication bias if the studies included≥5,and no test was needed if the studies included<5.Results:Document retrieval:8 relevant literatures conforming to the standards were included.There were 329 patients,including 160 patients in LRRHC group and 169 patients in ORRHC group.The Meta analysis results LRRHC group had a longer operation time,less intraoperative blood loss,postoperative analgesia,postoperative complications and postoperative hospital stay,the difference was statistically significant(P<0.05).There were no statistically significant differences between the LRRHC group and ORRHC group in the number of lymph node dissection,R0 resection,postoperative feeding time,1-year and 2-year survival rates(>0.05).Funnel plot analysiswas carried out in 8 literatures which shape was symmetrical,indicating that publication bias had little influence on Meta analysis results.Conclusion:LRRHC is safe and feasible in the treatment of hilar cholangiocarcinoma at the experienced clinical medical center for hepatobiliary and pancreatic diseases.Although LRRHC have a longer operation time than ORRHC,but LRRHC had less trauma,less intraoperative blood loss,better postoperative analgesia effect,lower incidence of postoperative complications and shorter hospitalization time,and the lymph node in number,R0 resection rate,postoperative eating time,1-year and 2-year survival rate were comparable to ORRHC.