结直肠癌肝转移灶首次切除和复发后第二次切除对比的Meta分析  

Meta-analysis of clinical outcome and safety of repeat hepatectomy versus first hepatectomy for patient with live metastases from colorectal cancer

作　　者：姜慧员[1] 梁小波[2] 侯生槐[2] 胡学忠[2] 李超亿[2] 马俊杰[2] 

机构地区：[1]山西医科大学第二临床医学院普外科,太原030001 [2]山西省肿瘤医院结直肠肛门外科

出　　处：《中华普通外科学文献（电子版）》2011年第2期50-53,共4页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的比较结直肠癌肝转移灶首次切除和复发后第二次切除临床疗效和安全性。方法检索1992年1月至2010年6月间发表的有关结直肠癌肝转移灶首次切除和复发后第二次切除对比的研究,按纳入和排除标准筛选后质量评分,提取临床效应指标,进行Meta分析。结果 22篇文献共计3750病例入选本次Meta分析。较之首次切除,复发后第二次切除手术时间增加平均39min(P<0.00001,95%CI=-65.21～-23.13);术中输血量增加1.1U(P<0.00001,95%CI=-1.75～-0.79)。术后ICU住院时间,术后失血及术后住院时间差异没有统计学意义。术后总并发症发生率及具体并发症发生率、远期疗效1年、3年、5年生存率、无瘤生存期及复发率差异没有统计学意义。结论与结直肠肝转移灶首次切除比较,复发后第二次切除具有其相似的手术安全性和有效性。复发后手术切除为首选方案,但是为了获得更有效的远期疗效,应进一步考虑综合治疗。Objective To compare clinical outcomes and safety of repeat hepatectomy for patients with liver metastases from colorectal cancer with those of a first liver resection.Methods The literature was searched for all studies reported on repeat hepatectomy versus a first liver resection patients with liver metastases from colorectal cancer between January 1992 to June 2010.According to inclusion and exclusion criteria,the clinical data were extracted.Trials were assessed using the modified Newcastle-Ottawa Score.Analysis were performed by RevMan 4.2.Results Twenty-two clinical studies were included in our systematic reviews.Compared with the first liver resection group,operation time of the repeat hepatectomy group was longer by 39 minutes[95% CI(-65.21,-23.13),P<0.00001],intraoperatie blood transfusions was longer by 1.1 U [95% CI(-1.75,-0.79),P<0.00001].There were no significant differences in the number of patient of length of intensive care unit stay,blood loss,length of hospitalization.There were no significant differences in the morbidity rate of post-operation complications,1,3,5-year overall survival,disease-free surial,the incidence of recurrence between the two groups.Conclusions Repeat hepatectomy for patients with colorectal cancer metastases is safe and provides survival benefit equal to that of a first liver resection.Repeat hepatectomy is first selection scheme,but in order to get a more effective long-term outcome,further consider comprehensive treatment should be considered.

关 键 词：结直肠癌 肝转移瘤 首次切除 二次切除 

分 类 号：R735.3[医药卫生—肿瘤]