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您现在的位置:首页 => 在线期刊 => 2019年 5期 “胰腺癌多学科综合诊疗”重点号 => 肝脏肿瘤 =>肝中叶切除与半肝切除..
肝中叶切除与半肝切除治疗中央型肝细胞癌效果比较的Meta分析
Clinical effect of mesohepatectomy versus hemihepatectomy in treatment of centrally located hepatocellular carcinoma: A Meta-analysis
文章发布日期:2019年04月04日  来源:  作者:余计赏,吴帆,谭国钳,等  点击次数:223次  下载次数:42次

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【摘要】:目的对肝中叶切除术和半肝切除术治疗中央型肝细胞癌的效果进行系统分析。方法通过计算机检索PubMed、EMBASE、Cochrane Library、中国知网、万方数据库和维普数据库中提供了肝中叶切除与半肝切除治疗中央型肝细胞癌对比研究的文献。提取手术时间、术中出血量、术后肝衰竭例数、围手术期病死率、总生存率和无瘤生存率等指标,并应用Review Manager 5.3软件进行数据分析。各研究间的异质性采用χ2检验判断。二分类变量采用比值比(OR)分析,连续性变量采用加权均数差(WMD)分析,两类变量均计算95%可信区间(95%CI)。结果共纳入符合标准的文献10篇,均为回顾性病例对照研究,总样本量1861例,其中肝中叶切除组1054例,半肝切除组807例。Meta分析结果显示肝中叶切除组患者术后肝衰竭的发生率低于半肝切除组(OR=0.37,95%CI:0.16~0.87,P=0.02);而手术时间(WMD=15.17,95%CI:-18.75~49.05,P=0.38)、术中出血量(WMD=10096,95%CI:-15.29~217.21,P=0.09)、围手术期病死率(OR=0.55,95%CI:0.26~1.17,P=0.12)、术后胆漏发生率(OR=1.32,95%CI:0.74~2.38,P=0.35)、总生存率和无瘤生存率等指标并无明显差异。结论肝中叶切除术可明显降低肝切除术后肝衰竭的风险,对于存在肝硬化的中央型肝细胞癌患者,有经验的医师可优先考虑肝中叶切除术。
【Abstract】:ObjectiveTo systematically review the clinical effect of mesohepatectomy versus hemihepatectomy in the treatment of centrally located hepatocellular carcinoma (HCC). MethodsPubMed, EMBASE, Cochrane Library, CKNI, Wanfang Data, and VIP were searched for comparative studies on mesohepatectomy versus hemihepatectomy in the treatment of centrally located HCC. Related data were extracted, including time of operation, intraoperative blood loss, number of patients with postoperative liver failure, mortality rate in the perioperative period, overall survival rate, and disease-free survival rate, and Review Manager 5.3 software was used for data analysis. The chi-square test was used to evaluate the heterogeneity between these studies. Odds ratio (OR) was used for the analysis of binary variables, weighted mean difference (WMD) was used for the analysis of continuous variables, and 95% confidence interval (CI) was calculated for these variables. ResultsA total of 10 retrospective case-control studies which met the inclusion criteria were included, with a total sample size of 1861 patients (1054 in the mesohepatectomy group and 807 in the hemihepatectomy group). The meta-analysis revealed that the mesohepatectomy group had a significantly lower incidence rate of postoperative liver failure than the hemihepatectomy group (OR=037, 95%CI: 0.16-0.87, P=0.02), while there were no significant differences between the two groups in time of operation (WMD=15.17, 95%CI: -18.75 to 49.05, P=0.38), intraoperative blood loss (WMD=100.96, 95%CI: -15.29 to 217.21, P=0.09), mortality rate in the perioperative period (OR=0.55, 95%CI: 0.26-1.17, P=0.12), incidence rate of bile leakage after surgery (OR=1.32, 95%CI: 0.74-2.38, P=0.35), overall survival rate, and disease-free survival rate. ConclusionMesohepatectomy can significantly reduce the risk of postoperative liver failure. For patients with centrally located HCC and liver cirrhosis, experienced surgeons may give priority to mesohepatectomy.
【关键字】:癌, 肝细胞; 肝中叶切除术; 半肝切除术; 治疗结果; Meta分析
【Key words】:carcinoma, hepatocellular; mesohepatectomy; hemihepatectomy; treatment outcome; Meta-analysis
【引证本文】:YU JS, WU F, TAN GQ, et al. Clinical effect of mesohepatectomy versus hemihepatectomy in treatment of centrally located hepatocellular carcinoma: A Meta-analysis[J]. J Clin Hepatol, 2019, 35(5): 1008-1013. (in Chinese)
余计赏, 吴帆, 谭国钳, 等. 肝中叶切除与半肝切除治疗中央型肝细胞癌效果比较的Meta分析[J]. 临床肝胆病杂志, 2019, 35(5): 1008-1013.

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