腹腔镜与开腹右半肝切除治疗肝肿瘤疗效比较的Meta分析
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摘要
目的:比较肝肿瘤行腹腔镜右半肝切除(LRH)与开腹右半肝切除(ORH)的临床疗效。方法:计算机检索英文及中文数据库关于LRH与ORH治疗肝肿瘤的对照研究,检索时间最后为2018年4月。对纳入的文献进行质量评价和数据提取后,采用RevMan 5.3软件行Meta分析。结果:共纳入7项研究,共计472例患者,其中LRH组207例,ORH组265例。Meta分析,结果显示,与ORH组比较,LRH组术中出血量减少(WMD=-166.14,95%CI=-254.59～-77.68,P<0.000 2)、并发症发生率降低(OR=0.35,95%CI=0.21～0.57,P<0.000 1)、住院时间缩短(WMD=-4.97,95%CI=-6.13～-3.81,P<0.000 01),但手术时间延长(WMD=51.39,95%CI=14.88～87.90,P=0.006);在输血率、病死率、手术切缘及肿瘤大小等方面无统计学差异(均P>0.05)。结论:LRH治疗肝肿瘤的临床效果与ORH无差异,且安全性好,然而该结论仍需更多高质量的研究予以验证。
Objective: To compare the clinical efficacy of laparoscopic right hemihepatectomy(LRH) and open right hemihepatectomy(ORH) in treatment of liver tumor. Methods: The controlled studies comparing LRH and ORH in treatment of liver tumor published in English and Chinese were searched through online databases. The retrieval time was up to April 2018. After the quality evaluation and data extraction of the included studies, Meta-analysis was conducted by using RevMan5.3 software.Results: Seven studies were finally included involving 472 patients, with 207 cases in LRH group and 265 in ORH group. The results of Meta-analysis showed that in LRH group compared with ORH group, the intraoperative blood loss was reduced(WMD=–166.14, 95% CI=–254.59––77.68, P<0.000 2), incidence of complications was decreased(OR=0.35, 95% CI=0.21–0.57, P<0.000 1) and length of postoperative hospital stay was shortened(WMD=–4.97, 95% CI=-6.13––3.81, P<0.000 01), while the operative time was prolonged(WMD=51.39,95% CI=14.88–87.90, P=0.006); no significant differences were noted with regard to the transfusion rate, mortality, surgical margin and tumor size(all P>0.05). Conclusion: LRH shows no difference in efficacy for the treatment of liver tumor compared with ORH, and also has better safety. However, this conclusion still needs to be verified by more high-quality studies.
Objective: To compare the clinical efficacy of laparoscopic right hemihepatectomy(LRH) and open right hemihepatectomy(ORH) in treatment of liver tumor. Methods: The controlled studies comparing LRH and ORH in treatment of liver tumor published in English and Chinese were searched through online databases. The retrieval time was up to April 2018. After the quality evaluation and data extraction of the included studies, Meta-analysis was conducted by using RevMan5.3 software.Results: Seven studies were finally included involving 472 patients, with 207 cases in LRH group and 265 in ORH group. The results of Meta-analysis showed that in LRH group compared with ORH group, the intraoperative blood loss was reduced(WMD=–166.14, 95% CI=–254.59––77.68, P<0.000 2), incidence of complications was decreased(OR=0.35, 95% CI=0.21–0.57, P<0.000 1) and length of postoperative hospital stay was shortened(WMD=–4.97, 95% CI=-6.13––3.81, P<0.000 01), while the operative time was prolonged(WMD=51.39,95% CI=14.88–87.90, P=0.006); no significant differences were noted with regard to the transfusion rate, mortality, surgical margin and tumor size(all P>0.05). Conclusion: LRH shows no difference in efficacy for the treatment of liver tumor compared with ORH, and also has better safety. However, this conclusion still needs to be verified by more high-quality studies.
引文
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[2]Reich H,McGlynn F,DeCaprio J,et al.Laparoscopic excision of benign liver lesions[J].Obstet Gynecol,1991,78(5 Pt 2):956-958.
[3]Buell JF,Cherqui D,Geller DA,et al.The international position on laparoscopic liver surgery:The Louisville Statement,2008[J].Ann Surg,2009,250(5):825-830.
[4]戴朝六,赵闯,徐锋.国内外腹腔镜肝切除术相关指南解读与比较[J].中国实用外科杂志,2017,37(5):539-542.doi:10.19538/j.cjps.issn1005-2208.2017.05.19.Dai CL,Zhao C,Xu F.Interpretation and comparison of guidelines for laparoscopic liver resection from China and abroad[J].Chinese Journal of Practical Surgery,2017,37(5):539-542.doi:10.19538/j.cjps.issn1005-2208.2017.05.19.
[5]Wakabayashi G,Cherqui D,Geller DA,et al.Recommendations for laparoscopic liver resection:a report from the second international consensus conference held in Morioka[J].Ann Surg,2015,261(4):619-629.doi:10.1097/SLA.0000000000001184.
[6]欧阳正晟,唐朝晖,吕丽娟,等.腹腔镜肝切除与开腹肝切除治疗原发性肝癌的临床比较[J].中国普通外科杂志,2017,26(1):126-130.doi:10.3978/.10.3978/j.issn.1005-6947.2017.01.021.Ouyang ZS,Tang ZH,Lu LJ,et al.Clinical comparison of laparoscopic and open hepatectomy in treatment of primary hepatic cancer[J].Chinese Journal of General Surgery,2017,26(1):126-130.doi:10.3978/.10.3978/j.issn.1005-6947.2017.01.021.
[7]Liu H,Wang D,Yu Y,et al.Meta-analysis of efficacy of laparoscopic hepatectomy versus open hepatectomy for hepatocarcinoma[J].J Cancer Res Ther,2017,13(5):849-855.doi:10.4103/jcrt.JCRT_533_17.
[8]Jiang B,Yan X,Zhang JH.Meta-analysis of laparoscopic versus open liver resection for hepatocellular carcinoma[J].Hepatol Res,2018,48(8):635-663.doi:10.1111/hepr.13061.
[9]Sotiropoulos GC,Prodromidou A,Machairas N.Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma:The European experience[J].J BUON,2017,22(5):1160-1171.
[10]Xu H,Liu F,Li H,et al.Outcomes following laparoscopic versus open major hepatectomy:a meta-analysis[J].Scand J Gastroenterol,2017,52(12):1307-1314.doi:10.1080/00365521.2017.1373846.
[11]Sotiropoulos GC,Prodromidou A,Kostakis,I D et al.Metaanalysis of laparoscopic vs open liver resection for hepatocellular carcinoma[J].Updates Surg,2017,69(3):291-311.doi:10.1007/s13304-017-0421-4.
[12]Chen J,Bai T,Zhang Y,et al.The safety and efficacy of laparoscopic and open hepatectomy in hepatocellular carcinoma patients with liver cirrhosis:a systematic review[J].Int J Clin Exp Med,2015,8(11):20679-20689.
[13]Peng L,Xiao J,Liu Z,et al.Laparoscopic Versus Open Left-Sided Hepatectomy for Hepatolithiasis:A Systematic Review and MetaAnalysis[J].J Laparoendosc Adv Surg Tech A,2017,27(9):951-958.doi:10.1089/lap.2016.0357.
[14]邰沁文,张金辉,温浩.腹腔镜与开腹行左半肝切除治疗原发性肝癌近期疗效及安全性的系统评价[J].中国循证医学杂志,2013,13(1):26-30.doi:10.7507/1672-2531.20130008.Tai QW,Zhang JH,Wen H.Short-Term Effectiveness and Safety of Laparoscopic versus Open Left Hepatectomy for Primary Cancer:A Systematic Review[J].Chinese Journal of Evidence-Based Medicine,2013,13(1):26-30.doi:10.7507/1672-2531.20130008.
[15]Abu Hilal M,Di Fabio F,Syed S,et al.Assessment of the financial implications for laparoscopic liver surgery:a single-centre UK cost analysis for minor and major hepatectomy[J].Surg Endosc,2013,27(7):2542-2550.doi:10.1007/s00464-012-2779-1.
[16]Dagher I,Di Giuro G,Dubrez J,et al.Laparoscopic versus open right hepatectomy:a comparative study[J].Am J Surg,2009,198(2):173-177.doi:10.1016/j.amjsurg.2008.09.015.
[17]Medbery RL,Chadid TS,Sweeney JF,et al.Laparoscopic vs open right hepatectomy:a value-based analysis[J].J Am Coll Surg,2014,218(5):929-939.doi:10.1016/j.jamcollsurg.2014.01.045.
[18]Yoon YI,Kim KH,Kang SH,et al.Pure Laparoscopic Versus Open Right Hepatectomy for Hepatocellular Carcinoma in Patients With Cirrhosis:A Propensity Score Matched Analysis[J].Ann Surg,2017,265(5):856-863.doi:10.1097/SLA.0000000000002072.
[19]Zhang Y,Chen XM,Sun DL.Short-term Outcomes of Laparoscopic Versus Open Right Hemihepatectomy for Hepatocellular Carcinoma[J].Surg Laparosc Endosc Percutan Tech,2016,26(6):e157-160.doi:10.1097/SLE.0000000000000355.
[20]Goumard C,Komatsu S,Brustia R,et al.Technical feasibility and safety of laparoscopic right hepatectomy for hepatocellular carcinoma following sequential TACE-PVE:a comparative study[J].Surg Endosc,2017,31(5):2340-2349.doi:10.1007/s00464-016-5225-y.
[21]龚安安,张成武,周蒙滔.腹腔镜下右半肝切除术治疗右肝肿瘤的围手术期疗效评估[J].肝胆胰外科杂志,2017,29(4):271-275.doi:10.11952/j.issn.1007-1954.2017.04.002.Gong AA,Zhang CW,Zhou MT.The perioperative curative effect assessment of totally laparoscopic right hepatectomy in the treatment of right liver tumor[J].Journal of Hepatopancreatobiliary Surgery,2017,29(4):271-275.doi:10.11952/j.issn.1007-1954.2017.04.002.
[22]Mirnezami R,Mirnezami A H,Chandrakumaran K,et al.Short-and long-term outcomes after laparoscopic and open hepatic resection:systematic review and meta-analysis[J].HPB(Oxford),2011,13(5):295-308.doi:10.1111/j.1477-2574.2011.00295.x.
[23]Schmandra TC,Mierdl S,Bauer H,et al.Transoesophageal echocardiography shows high risk of gas embolism during laparoscopic hepatic resection under carbon dioxide pneumoperitoneum[J].Br J Surg,2002,89(7):870-876.doi:10.1046/j.1365-2168.2002.02123.x.
[24]Gupta R,Fuks D,Bourdeaux C,et al.Impact of intraoperative blood loss on the short-term outcomes of laparoscopic liver resection[J].Surg Endosc,2017,31(11):4451-4457.doi:10.1007/s00464-017-5496-y.
[25]Cai X.Laparoscopic liver resection:the current status and the future[J].HepatoBiliary Surg Nutr,2018,7(2):98-104.doi:10.21037/hbsn.2018.02.07.
[26]Cauchy F,Fuks D,Nomi T,et al.Risk factors and consequences of conversion in laparoscopic major liver resection[J].Br J Sur,2015,102(7):785-795.doi:10.1002/bjs.9806.
[27]Guro H,Cho JY,Han HS,et al.Current status of laparoscopic liver resection for hepatocellular carcinoma[J].Clin Mol Hepatol,2016,22(2):212-218.doi:10.3350/cmh.2016.0026.
[28]Xiong JJ,Altaf K,Javed MA,et al.Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma[J].World JGastroenterol,2012,18(45):6657-6668.doi:10.3748/wjg.v18.i45.6657.
[29]Novitsky YW,Litwin DE,Callery MP.The net immunologic advantage of laparoscopic surgery[J].Surg Endosc,2004,18(10):1411-1419.doi:10.1007/s00464-003-8275-x.
[30]Jarnagin WR,Gonen M,Fong Y,et al.Improvement in perioperative outcome after hepatic resection:analysis of 1,803 consecutive cases over the past decade[J].Ann Surg,2002,236(4):397-406.doi:10.1097/01.SLA.0000029003.66466.B3.
[31]Wei AC,Tung-Ping Poon R,Fan ST,et al.Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma[J].Br J Surg,2003,90(1):33-41.doi:10.1002/bjs.4018.
[32]Liu X,Min X,Ma Z,et al.Laparoscopic hepatectomy produces better outcomes for hepatolithiasis than open hepatectomy:An updated systematic review and meta-analysis[J].Int J Surg,2018,51:151-163.doi:10.1016/j.ijsu.2018.01.016.
[33]Komorowski AL,Mitu?JW,Wysocki WM,et al.Laparoscopic and open liver resection-a literature review with meta-analysis[J].Arch Med Sci,2017,13(3):525-532.doi:10.5114/aoms.2015.55545.
[34]Tozzi F,Berardi G,Vierstraete M,et al.Laparoscopic Versus Open Approach for Formal Right and Left Hepatectomy:A Propensity Score Matching Analysis[J].World J Surg,2018,42(8):2627-2634.doi:10.1007/s00268-018-4524-y.
[35]van der Poel MJ,Besselink MG,Cipriani F,et al.Outcome and Learning Curve in 159 Consecutive Patients Undergoing Total Laparoscopic Hemihepatectomy[J].JAMA Surg,2016,151(10):923-928.doi:10.1001/jamasurg.2016.1655.
[36]Kim JH.Laparoscopy-specific ventral approach in laparoscopic hemihepatectomy[J].J Surg Oncol,2017,116(2):159-163.doi:10.1002/jso.24636.
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