摘要
目的系统评价肝下下腔静脉阻断联合Pringle阻断在肝切除术中应用的安全性及有效性。方法检索Pubmed、Cochrane中心、Embase、知网、维普、万方等数据库,依据纳入排除标准获取文献,对纳入的文献进行质量评价。提取相关数据,以Reavmanage5.3软件进行系统分析。结果共纳入14篇文献,1595例患者。荟萃分析显示,与单独Pringle阻断比较,联合阻断组术中总出血量更低(MD=-314.59,95%CI:-362.37^-266.81,P<0.05);切肝出血量更低(MD=-217.79,95%CI:-284.57^-151.00,P<0.05);术中输血率更低(OR=0.48,95%CI:0.36~0.62,P<0.05);并发症发生率更低(OR=0.74,95%CI:0.57~0.95,P<0.05);而在手术时间、住院时间、术中监测指标及术后肝功能、肾功能方面差异无统计学意义(P>0.05)。结论在肝切除术中应用肝下下腔静脉阻断联合Pringle阻断安全可靠,与单独Pringle阻断比较,减少了术中出血量,降低了并发症发生率,在临床中值得推广。
Objective To study the safety and effectiveness of infra-hepatic inferior vena cava clamping combined with Pringle’s maneuver during hepatectomy. Methods The databases of PubMed, Cochrane Center, CNKI, VIP, Wan Fang were searched to extract the relevant data for the meta-analysis using the Revmanage 5.3 software. Results A total of 14 studies with 1595 patients were included in this meta-analysis. The results showed that total bleeding during the combined clamping was significantly lower than that of the Pringle’s maneuver alone (MD=-314.59, 95%CI:-362.37^-266.81, P<0.05). Bleeding during hepatectomy was significantly lower (MD=-217.79, 95% CI:-284.57^-151.00, P<0.05);so was the intraoperative blood transfusion rate (OR=0.48, 95% CI: 0.36~0.62, P<0.05). The incidence of complications was significantly lower (OR=0.74, 95% CI: 0.57~0.95, P<0.05). However, there were no significant differences in operation time, length of hospital stay, intraoperative monitoring index and postoperative liver and kidney function recovery (P>0.05). Conclusions Infra-hepatic inferior vena cava clamping combined with Pringle’s maneuver in hepatectomy was safe and reliable. Compared with the Pringle’s maneuver alone, the combined technique reduce bleeding and the incidence of complications. This technique is worth promoting in clinical practice.
作者
赵欣
雷泽华
高峰畏
乌建平
付金强
杜波
王志旭
Zhao Xin;Lei Zehua;Gao Fengwei;Wu Jianping;Fu Jinqiang;Du Bo;Wang Zhixu(Department of Hepatopancreaticobiliary Surgery,Le Shan People’s Hospital of Sichuan Province,Leshan 614000,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2019年第10期728-732,共5页
Chinese Journal of Hepatobiliary Surgery
