同时性结直肠癌肝转移行一期和二期肝切除术安全性及疗效荟萃分析  

Safety and efficacy of simultaneous resection and staged resection for synchronous colorectal liver metastases:A Meta analysis

作　　者：魏猛[1] 耿小平[1] 赵红川[1] 王国斌[1] 黄帆[1] 

机构地区：[1]安徽医科大学第一附属医院普外五病区(器官移植中心),安徽合肥230022

出　　处：《中国实用外科杂志》2013年第5期380-385,共6页Chinese Journal of Practical Surgery

基　　金：安徽省卫生厅医学科研重点项目(2010A009)

摘　　要：目的评估同时性结直肠癌肝转移(SCLM)病人行一期和二期肝切除术的安全性及疗效。方法通过检索Medline数据库,Cochrane图书馆和Google学术搜索,搜集自1999年12月至2012年5月间关于SCLM病人行一期和二期肝切除术的对照研究,对手术资料和预后等进行荟萃分析。结果共纳入14篇文献,2588例SCLM病人,其中一期同步肝切除手术者931例,二期分阶段肝切除手术者1657例。一期手术术后并发症发生率(41.1%)低于二期手术(44.8%),且差异有统计学意义[OR0.79,95%CI,0.65～0.95,P=0.01];同时一期手术术中出血量较少(P=0.02)、住院时间较短(P=0.00);而在围手术期病死率、3年无瘤存活率、5年存活率、手术时间方面一期与二期手术相比差异无统计学意义(P值分别为0.26,0.19,0.86,0.05);其中对于切除3个或以上肝段的大块肝切除,一期与二期手术的手术并发症发生率(P=0.26)、围手术期病死率(P=0.26)差异亦无统计学意义。结论对于可行二期手术的SCLM病人,行一期手术治疗可取得与二期手术相似的治疗效果及并发症发生率;在适当选择的SCLM病人中,同时切除肝转移灶和原发肿瘤的一期手术可被作为首选治疗方案。Objective To evaluate the safety and efficacy of simultaneous resection and staged resection for synchronous colorectal liver metastasis （SCLM）. Methods Medline, Cochrane Library and Google Scholar were searched from December 1999 to May 2012 to identify the case-control studies comparing outcomes following simultaneous resection and staged resection for SCLM. Results Fourteen case-control studies with a total of 2588 patients of SCLM undergone curative hepatic resection were reviewed. There were 931 simultaneous and 1657 staged resections. Complication incidence in simultaneous resection group was lower than that in staged resection group （41.1% vs. 44.8%）, and the difference was statistically significant （OR 0.79,95%CI, 0.65- 0.95, P=0.01）. Less blood loss （P= 0.02） and shorter hospital stay （P=0.00） were observed in simultaneous resection group. No significant difference was found in perioperative mortality rate （P=0.26）, 3 years tumor-free survival rate （P=0.19）, 5 years overall survival rate （P= 0.86） and operative time （P=0.05） between two groups. Particularly, for major liver resections （resection of three or more segments）, the surgical complication incidence （P=0.26） and perioperative mortality rate （P=0.26） in the simultaneous resection group have not statistical difference compared with that in the staged resection group. Conclusion Simultaneous resection is safe and efficient in the treatment of patients with SCLM who can undergo staged resection. In appropriately selected patients, simultaneous resection might be considered as the preferred treatment.

关 键 词：结直肠肿瘤 同时性肝转移 一期肝切除术 二期肝切除术 荟萃分析 

分 类 号：R6[医药卫生—外科学]