中国循证医学杂志

中国循证医学杂志

腹腔镜与开腹手术比较治疗肝癌合并肝硬化患者疗效的 Meta 分析

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目的比较腹腔镜肝切除(LH)与开腹肝切除(OH)治疗肝癌合并肝硬化的疗效。方法计算机检索 PubMed、EMbase、Web of Science、The Cochrane Library、CBM、WanFang Data 和 CNKI 数据库,搜集比较 LH 与 OH 治疗肝癌合并肝硬化患者疗效的队列研究,检索时限均从建库至 2017 年 11 月 31 日。由 2 名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。结果共纳入 15 个队列研究,包括 1 720 例患者。Meta 分析结果显示:与 OH 相比,LH 术中出血量更少[MD=–226.94,95%CI(–339.87,–114.01),P<0.000 1]、输血率更低[OR=0.48,95%CI(0.27,0.83),P=0.009]、并发症更少[OR=0.32,95%CI(0.23,0.45),P<0.000 01]、住院时间更短[MD=–3.66,95%CI(–5.19,–2.14),P<0.000 01]、死亡率更低[OR=0.47,95%CI(0.24,0.92),P=0.03]、切缘较宽[OR=0.78,95%CI(0.20,1.36),P=0.009],1 年生存率[OR=2.47,95%CI(1.35,4.51),P=0.003]、3 年生存率[OR=1.62,95%CI(1.11,2.36),P=0.01]、5 年生存率[OR=1.58,95%CI(1.19,2.10),P=0.002]及 1 年无病生存率[OR=1.69,95%CI(1.20,2.39),P=0.003]更高。但两组在手术时间[MD=28.64,95%CI(–7.53,64.82),P=0.12]、肿瘤大小[MD=–0.37,95%CI(–0.75,0.02),P=0.06]、3 年无病生存率[OR=1.14,95%CI(0.86,1.51),P=0.36]和 5 年无病生存率[OR=0.99,95%CI(0.77,1.28),P=0.97]方面差异无统计学意义。结论LH 治疗肝癌合并肝硬化患者的术中、术后短期效果更好,且具有较好的长期预后。受纳入研究数量和质量限制,上述结论尚待更多高质量研究予以验证。

ObjectivesTo systematically review the efficacy of laparoscopic hepatectomy (LH) and open hepatectomy (OH) on the hepatocellular carcinoma patients with cirrhosis.MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were searched online to collect the cohort studies of LHvs.OH on hepatocellular carcinoma patients with cirrhosis from inception to November 31st, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 15 cohort studies involving 1 720 patients were included. The results of meta-analysis showed that: compared with OH, LH had less blood loss (MD=–226.94, 95%CI –339.87 to –114.01, P<0.000 1), lower transfusion rate (OR=0.48, 95%CI 0.27 to 0.83,P=0.009), less occurrence of complications (OR=0.32, 95%CI 0.23 to 0.45, P<0.000 01), shorter postoperative hospital stay (MD=–3.66, 95%CI –5.19 to –2.14,P<0.000 01), lower mortality rate (OR=0.47, 95%CI 0.24 to 0.92,P=0.03), wider surgical margin (OR=0.78, 95%CI 0.20 to 1.36, P=0.009), higher 1, 3 and 5-year survival rate (OR=2.47, 95%CI 1.35 to 4.51, P=0.003; OR=1.62, 95%CI 1.11 to 2.36, P=0.01; OR=1.58, 95%CI 1.19 to 2.10, P=0.002, respectively) and 1-year disease free survival rate (OR=1.69, 95%CI=1.20 to 2.39, P=0.003). There were no significant differences in operation time (MD=28.64, 95%CI –7.53 to 64.82, P=0.12), tumor size (MD=–0.37, 95%CI –0.75 to 0.02, P=0.06), 3-year disease free survival rate (OR=1.14, 95%CI 0.86 to 1.51, P=0.36) and 5-year disease free survival rate (OR=0.99, 95%CI 0.77 to 1.28, P=0.97) between the two groups.ConclusionsThe perioperation and short-term postoperative outcomes of LH are significant in HCC patients with cirrhosis, and which have good long-term prognosis. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

关键词: 腹腔镜肝切除; 开腹肝切除; 肝癌; 肝硬化; Meta 分析; 系统评价; 队列研究

Key words: Laparoscopic hepatectomy; Open hepatectomy; Hepatocellular carcinoma; Cirrhosis; Meta-analysis; Systematic review; Cohort study

引用本文: 江松, 王兆映, 欧明瑞, 崔培元. 腹腔镜与开腹手术比较治疗肝癌合并肝硬化患者疗效的 Meta 分析. 中国循证医学杂志, 2018, 18(9): 931-940. doi: 10.7507/1672-2531.201802054 复制

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