腹腔镜脾切除与开腹脾切除治疗肝硬变门静脉高压致脾功能亢进疗效比较的系统评价  

Systematic Review of Effect of Laparoscopic Splenectomy and Open Splenectomy for Hypersplenism Secondary to Liver Cirrhosis with Portal Hypertension

作　　者：田浪[1] 胡勇[1] 冯燮林[1] 刘爱祥[1] 张辉[1] 彭俊平[1] 

机构地区：[1]四川省肿瘤医院肝胆外科,四川成都610041

出　　处：《中国普外基础与临床杂志》2013年第3期293-302,共10页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的系统评价腹腔镜脾切除(LS)与开腹脾切除(OS)治疗肝硬变门静脉高压致脾功能亢进的疗效。方法计算机检索了Cochrane Central Register of Controlled Trials、Cochrane Database of Systematic Reviews、Medline、Embase、CINAHL、CBM、CNKI、VIP和万方数据库中,所有关于LS术(LS组)与OS术(OS组)治疗肝硬变门静脉高压致脾功能亢进的随机对照试验和临床同期对照试验。根据纳入和排除标准筛选文献、提取资料和进行质量评价后,采用RevMan 5.1.0软件进行Meta分析。结果共纳入17篇临床同期对照试验和1篇随机对照试验。Meta分析结果显示:LS组患者的术中出血量、术后住院时间、术后并发症发生率及术后1 d的白细胞水平均低(短)于OS组(P<0.05);其手术时间、术后7 d的白细胞水平、术后血小板计数(1 d和7 d)、术后丙氨酸氨基转移酶水平(1 d和7 d)和术后总胆红素水平(1 d和7 d)与OS组比较差异均无统计学意义(P>0.05)。结论 LS术有助于减少肝硬变门静脉高压致脾功能亢进患者的术中出血量,缩短术后住院时间,减少术后并发症的发生;但目前的证据尚不能证明LS术能改善此类患者的肝功能。Objective To evaluate the effect of laparoscopic splenectomy（LS） and open splenectomy（OS） for hypersplenism secondary to liver cirrhosis with portal hypertension.Methods Cochrane Central Register of Controlled Trials,Cochrane Database of Systematic Reviews,Medline,Embase,CINAHL,CBM,CNKI,VIP and WanFang database were searched for randomized control trials or retrospective studies related to the effect of LS and OS for hypersplenism secondary to liver cirrhosis with portal hypertension.Then studies were screened according to the inclusion and exclusion criterias,data were collected,and quality of studies were evaluated.RevMan 5.1.0 software was used for metaanalysis.Results Seventeen retrospective studies and one randomized control trial were enrolled.The results of meta analysis showed that,the estimated blood loss,postoperative hospital stay,rate of postoperative complication,and WBC level on 1 day after operation of LS group were significantly lower or shorter than those of OS group（P0.05）.However, there were no significant differences on operative time,WBC level on 7 days after operation,postoperative platelets（1 day and 7 days after operation）,alanine aminotransferase（1 day and 7 days after operation）,and total bilirubin（1 day and 7 days after operation） between LS group and OS group（P0.05）.Conclusions LS may be more effective to reduce blood loss,postoperative hospital stay,and rate of postoperative complication in patients with hypersplenism secondary to liver cirrhosis with portal hypertension in comparison to OS.However,the effectiveness of LS on liver function is not clear.

关 键 词：肝硬变 脾功能亢进 腹腔镜脾切除 开腹脾切除 系统评价 

分 类 号：R657.31[医药卫生—外科学]