AIM To perform a meta-analysis on laparoscopic hepatectomy VS conventional liver resection for treating hepatolithiasis.METHODS We conducted a systematic literature search on Pub Med,Embase,Web of Science and Cochrane...AIM To perform a meta-analysis on laparoscopic hepatectomy VS conventional liver resection for treating hepatolithiasis.METHODS We conducted a systematic literature search on Pub Med,Embase,Web of Science and Cochrane Library,and undertook a meta-analysis to compare the efficacy and safety of laparoscopic hepatectomy V S conventional open liver resection for local hepatolithiasis in the left or right lobe. Intraoperative and postoperative outcomes(time,estimated blood loss,blood transfusion rate,postoperative intestinal function recovery time,length of hospital stay,postoperative complication rate,initial residual stone,final residual stone and stone recurrence) were analyzed systematically.RESULTS A comprehensive literature search retrieved 16 publications with a total of 1329 cases. Meta-analysis of these studies showed that the laparoscopic approach for hepatolithiasis was associated with significantly less intraoperative estimated blood loss [weighted mean difference(WMD): 61.56,95% confidence interval(CI): 14.91-108.20,P = 0.01],lower blood transfusion rate [odds ratio(OR): 0.41,95%CI: 0.22-0.79,P = 0.008],shorter intestinal function recovery time(WMD: 0.98,95%CI: 0.47-1.48,P = 0.01),lower total postoperative complication rate(OR: 0.52,95%CI: 0.39-0.70,P < 0.0001) and shorter stay in hospital(WMD: 3.32,95%CI: 2.32-4.32,P < 0.00001). In addition,our results showed no significant differences between the two groups in operative time(WMD: 21.49,95%CI: 0.27-43.24,P = 0.05),residual stones(OR: 0.79,95%CI: 0.50-1.25,P = 0.31) and stone recurrence(OR: 0.34,95%CI: 0.11-1.08,P = 0.07). Furthermore,with subgroups analysis,our results proved that the laparoscopic approach for hepatolithiasis in the left lateral lobe and left side could achieve satisfactory therapeutic effects. CONCLUSION The laparoscopic approach is safe and effective,with less intraoperative estimated blood loss,fewer postoperative complications,reduced length of hospital stay and shorter intestinal function recovery time than with conventional approac展开更多
目的评价成人接种乙肝基因疫苗后的免疫效果。方法文献检索符合本研究分析条件的成人乙肝基因疫苗接种免疫效果论文10篇,5篇为实验对照研究,5篇为平行对照研究,用抗HBs的转阳率作为效果指标;采用Meta分析中的固定效应模型(General Varia...目的评价成人接种乙肝基因疫苗后的免疫效果。方法文献检索符合本研究分析条件的成人乙肝基因疫苗接种免疫效果论文10篇,5篇为实验对照研究,5篇为平行对照研究,用抗HBs的转阳率作为效果指标;采用Meta分析中的固定效应模型(General Variance-Based法)和随机效应模型(Der Si monian and Laird法)统计方法进行分析。结果实验对照研究论文经Meta分析,公共OR的估计值为2·842,95%的可信区间为(1·329,4·354),实验组和对照组的抗HBs转阳率差别有统计学意义;平行对照研究论文经Meta分析,公共OR的Mantel-Haeszel估计值为0·6592,相应的95%的可信区间为(0·5435,0·7994),男性组和女性组的抗HBs转阳率差别有统计学意义。结论成人接种乙肝基因疫苗的免疫仍有较好效果,加强对中青年人群的乙肝疫苗接种宣传,控制人群HBsAg感染率。展开更多
AIM:To evaluate the impact of enhanced recovery after surgery(ERAS) programs in comparison with traditional care on liver surgery outcomes.METHODS:The Pub Med,EMBASE,CNKI and Cochrane Central Register of Controlled Tr...AIM:To evaluate the impact of enhanced recovery after surgery(ERAS) programs in comparison with traditional care on liver surgery outcomes.METHODS:The Pub Med,EMBASE,CNKI and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials(RCTs) comparing the ERAS program with traditional care in patients undergoing liver surgery. Studies selected for the meta-analysis met all of the following inclusion criteria:(1) evaluation of ERAS in comparison to traditional care in adult patients undergoing elective open or laparoscopic liver surgery;(2) outcome measures including complications,recovery of bowel function,and hospital length of stay; and(3) RCTs. The following exclusion criteria were applied:(1) the study was not an RCT;(2) the study did not compare ERAS with traditional care;(3) the study reported on emergency,non-elective or transplantation surgery; and(4) the study consisted of unpublished studies with only the abstract presented at a national or international meeting. The primary outcomes were complications. Secondary outcomes were length of hospital stay and time to first flatus.RESULTS:Five RCTs containing 723 patients were included in the meta-analysis. In 10/723 cases,patients presented with benign diseases,while the remaining 713 cases had liver cancer. Of the five studies,three were published in English and two were published in Chinese. Three hundred and fifty-four patients were in the ERAS group,while 369 patients were in the traditional care group. Compared with traditional care,ERAS programs were associated with significantly decreased overall complications(RR = 0.66; 95%CI:0.49-0.88; P = 0.005),grade?Ⅰ?complications(RR = 0.51; 95%CI:0.33-0.79; P = 0.003),and hospitallength of stay [WMD =-2.77 d,95%CI:-3.87-(-1.66); P < 0.00001]. Similarly,ERAS programs were associated with decreased time to first flatus [WMD =-19.69 h,95%CI:-34.63-(-4.74); P < 0.0001]. There was no statistically significant difference in grade Ⅱ-Ⅴ complications between the two group展开更多
基金Supported by National Natural Science Foundation of China,No.81372243,No.81570593 and No.81370575Key Scientific and Technological Projects of Guangdong Province,No.2014B020228003 and No.2014B030301041+2 种基金Natural Science Foundation of Guangdong Province,No.2015A030312013Science and Technology Planning Project of Guangzhou,No.201400000001-3,No.201508020262 and No.2014J4100128Science and Technology Planning Project of Guangdong Province,No.2017A020215178
文摘AIM To perform a meta-analysis on laparoscopic hepatectomy VS conventional liver resection for treating hepatolithiasis.METHODS We conducted a systematic literature search on Pub Med,Embase,Web of Science and Cochrane Library,and undertook a meta-analysis to compare the efficacy and safety of laparoscopic hepatectomy V S conventional open liver resection for local hepatolithiasis in the left or right lobe. Intraoperative and postoperative outcomes(time,estimated blood loss,blood transfusion rate,postoperative intestinal function recovery time,length of hospital stay,postoperative complication rate,initial residual stone,final residual stone and stone recurrence) were analyzed systematically.RESULTS A comprehensive literature search retrieved 16 publications with a total of 1329 cases. Meta-analysis of these studies showed that the laparoscopic approach for hepatolithiasis was associated with significantly less intraoperative estimated blood loss [weighted mean difference(WMD): 61.56,95% confidence interval(CI): 14.91-108.20,P = 0.01],lower blood transfusion rate [odds ratio(OR): 0.41,95%CI: 0.22-0.79,P = 0.008],shorter intestinal function recovery time(WMD: 0.98,95%CI: 0.47-1.48,P = 0.01),lower total postoperative complication rate(OR: 0.52,95%CI: 0.39-0.70,P < 0.0001) and shorter stay in hospital(WMD: 3.32,95%CI: 2.32-4.32,P < 0.00001). In addition,our results showed no significant differences between the two groups in operative time(WMD: 21.49,95%CI: 0.27-43.24,P = 0.05),residual stones(OR: 0.79,95%CI: 0.50-1.25,P = 0.31) and stone recurrence(OR: 0.34,95%CI: 0.11-1.08,P = 0.07). Furthermore,with subgroups analysis,our results proved that the laparoscopic approach for hepatolithiasis in the left lateral lobe and left side could achieve satisfactory therapeutic effects. CONCLUSION The laparoscopic approach is safe and effective,with less intraoperative estimated blood loss,fewer postoperative complications,reduced length of hospital stay and shorter intestinal function recovery time than with conventional approac
文摘目的评价成人接种乙肝基因疫苗后的免疫效果。方法文献检索符合本研究分析条件的成人乙肝基因疫苗接种免疫效果论文10篇,5篇为实验对照研究,5篇为平行对照研究,用抗HBs的转阳率作为效果指标;采用Meta分析中的固定效应模型(General Variance-Based法)和随机效应模型(Der Si monian and Laird法)统计方法进行分析。结果实验对照研究论文经Meta分析,公共OR的估计值为2·842,95%的可信区间为(1·329,4·354),实验组和对照组的抗HBs转阳率差别有统计学意义;平行对照研究论文经Meta分析,公共OR的Mantel-Haeszel估计值为0·6592,相应的95%的可信区间为(0·5435,0·7994),男性组和女性组的抗HBs转阳率差别有统计学意义。结论成人接种乙肝基因疫苗的免疫仍有较好效果,加强对中青年人群的乙肝疫苗接种宣传,控制人群HBsAg感染率。
文摘AIM:To evaluate the impact of enhanced recovery after surgery(ERAS) programs in comparison with traditional care on liver surgery outcomes.METHODS:The Pub Med,EMBASE,CNKI and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials(RCTs) comparing the ERAS program with traditional care in patients undergoing liver surgery. Studies selected for the meta-analysis met all of the following inclusion criteria:(1) evaluation of ERAS in comparison to traditional care in adult patients undergoing elective open or laparoscopic liver surgery;(2) outcome measures including complications,recovery of bowel function,and hospital length of stay; and(3) RCTs. The following exclusion criteria were applied:(1) the study was not an RCT;(2) the study did not compare ERAS with traditional care;(3) the study reported on emergency,non-elective or transplantation surgery; and(4) the study consisted of unpublished studies with only the abstract presented at a national or international meeting. The primary outcomes were complications. Secondary outcomes were length of hospital stay and time to first flatus.RESULTS:Five RCTs containing 723 patients were included in the meta-analysis. In 10/723 cases,patients presented with benign diseases,while the remaining 713 cases had liver cancer. Of the five studies,three were published in English and two were published in Chinese. Three hundred and fifty-four patients were in the ERAS group,while 369 patients were in the traditional care group. Compared with traditional care,ERAS programs were associated with significantly decreased overall complications(RR = 0.66; 95%CI:0.49-0.88; P = 0.005),grade?Ⅰ?complications(RR = 0.51; 95%CI:0.33-0.79; P = 0.003),and hospitallength of stay [WMD =-2.77 d,95%CI:-3.87-(-1.66); P < 0.00001]. Similarly,ERAS programs were associated with decreased time to first flatus [WMD =-19.69 h,95%CI:-34.63-(-4.74); P < 0.0001]. There was no statistically significant difference in grade Ⅱ-Ⅴ complications between the two group
