腹腔镜与开腹手术治疗肝细胞癌的Meta分析

叶钢; 马钰; 唐成佳; 杜成友

腹腔镜与开腹手术治疗肝细胞癌的Meta分析

重庆医科大学附属第一医院肝胆外科

详细信息

中图分类号: R735.7
计量
- 文章访问数: 3070
- HTML全文浏览量: 27
- PDF下载量: 741
- 被引次数: 0
出版历程
- 出版日期: 2013-03-20

Clinical outcomes of laparoscopic hepatectomy and open hepatectomy for hepatocellular carcinoma: A meta-analysis

摘要

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...
- 肝肿瘤 /
- 腹腔镜检查 /
- 外科手术 /
- Meta分析
Abstract:
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, P<0.0001) , 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.
- liver neoplasms /
- laparoscopy /
- surgical procedures /
- operative

HTML全文

参考文献(42)

[1]Llovet JM, Burroughs A, Bruix J.Hepatocellular carcinoma[J].Lancet, 2003, 362 (9399) :1907-1917.

[2] Parkin DM, Bray F, Ferlay J, et al.Global cancer statistics, 2002[J].CA Cancer J Clin, 2005, 55 (2) :74-108.

[3]Venook AP, Papandreou C, Furuse J, et al.The incidence and epide-miology of hepatocellular carcinoma:a global and regional perspective[J].Oncologist, 2010, 15 (Suppl 4) :5-13.

[4]Mazzaferro V, Chun YS, Poon RT, et al.Liver transplantation forhepatocellular carcinoma[J].Ann Surg Oncol, 2008, 15 (4) :1001-1007.

[5]Laurent A, Cherqui D, Lesurtel M, et al.Laparoscopic liver resec-tion for subcapsular hepatocellular carcinoma complicating chronicliver disease[J].Arch Surg, 2003, 138 (7) :763-769.

[6]Nguyen KT, Gamblin TC, Geller DA.World review of lapa roscop-ic liver resection 2, 804 patients[J].Ann Surg, 2009, 250 (5) :831-841.

[7]Hu BS, Chen K, Tan HM, et al.Comparison of laparoscopic vs openliver lobectomy (segmentectomy) for hepatocellular carcinoma[J].World J Gastroenterol, 2011, 17 (42) :4725-4728.

[8]Shimada M, Hashizume M, Maehara S, et al.Laparoscopic hepa-tectomy for hepatocellular carcinoma[J].Surg Endosc, 2001, 15 (6) :541-544.

[9]Lai EC, Tang CN, Ha JP, et al.Laparoscopic liver resection forhepatocellular carcinoma:ten-year experience in a single center[J].Arch Surg, 2009, 144 (2) :143-147.

[10]Sarpel U, Hefti MM, Wisnievsky JP, et al.Outcome for patientstreated with laparoscopic versus open esection of hepatocellular car-cinoma:case-matched analysis[J].Ann Surg Oncol, 2009, 16 (6) :1572-1577.

[11]Aldrighetti L, Guzzetti E, Pulitano C, et al.Case-matched analy-sis of totally laparoscopic versus open liver resection for HCC:shortand middle term results[J].J Surg Oncol, 2010, 102 (1) :82-86.

[12]Tranchart H, Di Giuro G, Lainas P, et al.Laparoscopic resection forhepatocellular carcinoma:a matched-pair comparative study[J].SurgEndosc, 2010, 24 (5) :1170-1176.

[13]Nguyen KT, Marsh JW, Tsung A, et al.Comparative benefits oflaparoscopic vs open hepatic resection:a critical appraisal[J].Arch Surg, 2011, 146 (3) :348-356.

[14]Lee KF, Chong C N, Wong J, et al.Long-Term Results of Lapa-roscopic Hepatectomy Versus Open Hepatectomy for HepatocellularCarcinoma:A Case-Matched Analysis[J].World J Surg, 2011, 35 (10) :2268-2274.

[15]Kim HH, Park EK, Seoung JS, et al.Liver resection for hepatocel-lular carcinoma:case-matched analysis of laparoscopic versus openresection[J].Korean Surg Soc, 2011, 80 (6) :412-419.

[16]Ker CG, Chen JS, Kuo KK, et al.Liver Surgery for HepatocellularCarcinoma:Laparoscopic versus Open Approach[J].Int J Hepatol, 2011, 2011:596792.

[17]Truant S, Bouras AF, Hebbar M, et al.Laparoscopic resection vs.open liver resection for peripheral hepatocellular carcinoma in patientswith chronic liver disease:a case-matched study[J].Surg Endosc, 2011, 25 (11) :3668-3677.

[18]Wells GA, Shea B, O’Connell D, et al.The Newcastle-OttawaScale (NOS) for assessing the quality of nonrandomized studies inmeta-analyses[J].The Ottawa Health Research Institute, 2010.

[19]Athanasiou T, Al-Ruzzeh S, Kumar P, et al.Off-pump myocar-dial revascularization is associated with less incidence of stroke inelderly patients[J].Ann Thorac Surg, 2004, 77 (2) :745-753.

[20]Mathurin P, Raynard B, Dharancy S, et al.Meta-analysis:eval-uation of adjuvant therapy after curative liver resection for hepatocel-lular carcinoma[J].Aliment Pharmacol Ther, 2003, 17 (10) :1247-1261.

[21]Novitsky YW, Litwin DE, Callery MP.The net immunologic advan-tage of laparoscopic surgery[J].Surg Endosc, 2004, 18 (10) :1411-1419.

[22]张绍庚, 魏炜明, 陈永标, 等.腹腔镜肝切除30例[J].消化外科, 2005, 4 (2) :87-89.

[23]Cherqui D, Laurcnt A, Tayer C, et al.Laparoscopic liver resectionfor peripheral hepatnoelinlar carcinoma in patients with chrooic liverdisease:midterra results and perspectives[J].Aan Surf, 2006, 243 (4) :499-506.

[24]Suh KS, Yi NJ, Kim J, et al.Laparoscopic hepatectomy for a modifiedright graft in adult-to-adult living donor liver transplantation[J].Transplant Proc, 2008, 40 (10) :3529-3231.

[25]Coelho JC, Freitas AC, Mathias JE.Laparoscopic resection of the leftlateral segment of the liver in living donor liver transplantation[J].RevCol Bras Cir, 2009, 36 (6) :537-538.

[26]Baker TB, Jay CL, Ladner DP, et al.Laparoscopy-assisted anopen living donor right hepatectomy:a comparative study of out-comes[J].Surgery, 2009, 146 (4) :817-823.

[27]Belli G, Fantini C, D'Agostino A, et al.Laparoscopic versus openliver resection for hepatocellular carcinoma in patients with histologi-cally proven cirrhosis:short-and middle-term results[J].SurgEndosc, 2007, 21 (11) :2004-2011.

[28]Buell JF, Cherqui D, Geller DA, et al.The international positionon laparoscopic liver surgery:The Louisville Statement, 2008[J].Ann Surg, 2009, 250 (5) :825-830.

[29]Ito K, Ito H, Are C, et al.Laparoscopic versus open liver resec-tion:a matched-pair case control study[J].J Gastrointest Surg, 2009, 13 (12) :2276-2283.

[30]Cai XJ, Yang J, Yu H, et al.Clinical study of laparoscopic versusopen hepatectomy for malignant liver tumors[J].Surg Endosc, 2008, 22 (11) :2350-2356.

[31]Endo Y, Ohta M, Sasaki A, et al.Acomparative study of the long-term outcomes after aparoscopy-assisted and open left lateral hepatec-tomy for hepatocellular carcinoma[J].Surg Laparosc Endosc PercutanTech, 2009, 19 (5) :e171-174.

[32]Topal B, Fieuws S, Aerts R, et al.Laparoscopic versus open liverresection of hepatic neoplasms:comparative analysis of short-termresults[J].Surg Endosc, 2008, 22 (10) :2208-2213.

[33]Gagner M, Rogula T, Selzer D.Laparoscopic liver resection:bene-fits and controversies[J].Surg Clin North Am, 2004, 84 (2) :451-462.

[34]Li N, Wu YR, WuB, et al.Surgical and oncologic outcomes fol-lowing laparoscopic versus open liver resection for hepatocellularcarcinoma:A meta-analysis[J].Hepatol Res, 2012, 42 (1) :51-59.

[35]郑树国, 李建伟, 李剑斌, 等.腹腔镜肝切除术的初步经验[J].消化外科, 2007, 6 (6) :424-427.

[36]Biertho L, Waage A, Gagner M.Laparoscopic hepatectomy[J].Ann Clair, 2002, 127 (3) :164-170.

[37]Kaneko H, Takagi S, Otsuka Y, et al.Laparoscopic liver resectionof hepatocellular carcinoma[J].Am J Surg, 2005, 189 (2) :190-194.

[38]Chen HY, Juan CC, Ker CG.Laparoscopic liver surgery for pa-tients with hepatocellular carcinoma[J].Ann Surg Oncol, 2008, 15 (3) :800-806.

[39]Dagher I, Lainas P, Carloni A, et al.Laparoscopic liver resectionfor hepatocellular carcinoma[J].Surg Endosc, 2008, 22 (2) :372-378.

[40]Cherqui D, Laurent A, Tayar C, et al.Laparoscopic liver resectionfor peripheral hepatocellular carcinoma in patients with chronic liverdisease:midterm results and perspectives[J].Ann Surg, 2006, 243 (4) :499-506.

[41]Belli G, Fantini C, D'Agostino A, et al.Laparoscopic liver resec-tions for hepatocellular carcinoma (HCC) in cirrhotic patients[J].HPB (Oxford) , 2004, 6 (4) :236-246.

[42]Abraham NS, Byrne CJ, Young JM, et al.Meta-analysis of well-designed nonrandomized comparative studies of surgical proce-dures is as good as randomized controlled trials[J].J Clin Epidemi-ol, 2010, 63 (3) :238-245.

施引文献

资源附件(0)

访问统计