摘要
目的系统评价腹腔镜与开腹手术治疗肝细胞癌的近远期疗效及安全性。方法计算机检索有关腹腔镜与开腹手术治疗肝细胞癌的随机对照试验及临床对照试验的所有英文文献,并采用Cochrane协作网专用软件RevMan 5.1对数据进行统计分析,采用比值比(OR)及其95%可信区间(95%CI)和加权均数(WMD)及其95%CI对结果进行分析。结果未获得随机对照实验,12个病例对照实验被纳入,合计980例患者,其中391例行腹腔镜,589例行开腹手术。Meta分析结果显示:(1)手术时间:两组差异无统计学意义(WMD=3.34,95%CI:-19.17～25.85,P=0.77);(2)术中输血率:腹腔镜组低于开腹手术组,差异有统计学意义(OR=0.48,95%CI:0.26～0.89,P=0.02);(3)术后住院天数:腹腔镜组短于开腹手术组,差异有统计学意义(WMD=-4.27,95%CI:-6.18～-2.37,P<0.0001);(4)术中出血量:腹腔镜组低于开腹手术组,差异有统计学意义(WMD=-242.5,95%CI:-458.67～-26.34,P=0.03);(5)术后并发症发生率:腹腔镜组低于开腹手术组,其差异有统计学意义(OR=0.48,95%CI:0.31～0.75,P=0.001);(6)手术切缘:两组差异无统计学意义(WMD=0.76,95%CI:-0.03～1.56,P=0.06);(7)住院期间病死率:腹腔镜组低于开腹手术组,差异有统计学意义(OR=0.24,95%CI:0.07～0.86,P=0.03);(8)术后1、3年总生存率及1、3、5年无瘤生存率,两组差异无统计学意义(OR=1.09,95%CI:0.70～1.68,P=0.71)(OR=1.31,95%CI:0.95～1.80,P=0.09;OR=1.52,95%CI:0.97～2.37,P=0.07;OR=0.94,95%CI:0.65～1.35,P=0.73;OR=1.14,95%CI:0.75～1.73,P=0.55);(9)术后5年生存率:腹腔镜组高于开腹手术组,差异有统计学意义(OR=1.61,95%CI:1.18～2.19,P=0.003)。结论腹腔镜治疗肝细胞癌作为一种微创手术,与开腹切除术相比,具有创伤小、恢复快、术中出血量少及术后并发症少等优点,腹腔镜肝切除有望成为肝细胞癌患者的首选治疗方案。
Objective To evaluate the short-and long-term efficacy and safety of laparoscopic hepatectomy（LH） and open hepatectomy（OH） treatment of hepatocellular carcinoma（HCC） using a systematic and comprehensive analysis of published cases.Methods Randomized controlled trials and case-control trials of LH and OH in HCC patients were retrieved from the public literature databases.Meta-analysis was carried out with the RevMan 5.1 software.Treatment effects were measured by calculating the odds ratio（OR） or the weighted mean difference（WMD）,with 95% confidence intervals（CIs）.Results Twelve studies were included in the analysis,and represented 980 patients（LH,n=391;OH,n=589）.The LH and OH operative times were not significantly different（WMD=3.34,95%CI：-19.17,25.85,P=0.77）.However,the LH group had significantly fewer blood transfusions（OR=0.48,95%CI：0.26,0.89,P=0.02）,shorter hospital stay（WMD=-4.27,95%CI：-6.18,-2.37,P0.0001）,less intraoperative blood loss（WMD=-242.5,95%CI：-458.67,-26.34,P=0.03）,and less complications（OR=0.48,95%CI：0.31,0.75,P=0.001）.The surgery margin was similar between the two procedures（LH vs.OH： WMD=0.76,95%CI：-0.03,1.56,P=0.06）.There were significant differences in outcomes between the two treatment groups.While the LH group had a significantly lower mortality（OR=0.24,95%CI：0.07,0.86,P=0.03）,there were no significant differences in the disease-free survival rates until the 5-year follow-up when the LH group showed a higher rate（OR=1.61,95%CI：1.18,2.19,P=0.003）.Conclusion Laparoscopy is a minimally invasive procedure,compared to open surgical resection.Laparoscopic resection of liver cancer results in less trauma,quicker recovery,less intraoperative blood loss,and fewer postoperative complications,and should be considered as the preferred treatment option for patients amenable to surgery.
出处
《临床肝胆病杂志》
CAS
2013年第3期184-190,共7页
Journal of Clinical Hepatology
关键词
肝肿瘤
腹腔镜检查
外科手术
META分析
liver neoplasms
laparoscopy
surgical procedures
operative
Meta-analysis
