直接行肝移植与肝切除后补救性肝移植治疗肝癌疗效的系统评价  

Meta-analysis of salvage liver transplantation versus primary liver transplantation in the treatment of hepatocellular carcinoma

作　　者：张日新[1] 郑小林[1] 郑直[1] 何涛[1] 李凯[1] 郑英键[1] 李明杰[1] 

机构地区：[1]武汉市中心医院肝胆胰腹腔镜外科,湖北武汉430014

出　　处：《中国现代医学杂志》2013年第23期70-74,共5页China Journal of Modern Medicine

摘　　要：目的评价PLT与SLT治疗肝癌的疗效。方法根据纳入标准,未获得随机对照试验,共纳入8个临床同期对照试验,合计599例患者,并用Rev Man 5.1版软件对资料进行统计分析。结果 Meta分析结果表明,①SLT相对于PLT手术时间更长[WMD=-31.46,95%C(I-59.45,-3.48),P=0.03]、术中出血量更多[WMD=-975.58,95%C(I-1293.99,-657.17),P<0.0001];②术后两者并发症比较差异无统计学意义。胆道并发症[OR=0.96,95%C(I0.48,1.91),P=0.90],肝动脉并发症[OR=0.91,95%C(I0.34,2.39),P=0.84],术后再移植[OR=1.17,95%C(I0.44,3.14),P=0.75],术后急性排斥反应[OR=0.55,95%C(I0.23,1.31),P=0.18],围术期死亡率[OR=1.48,95%C(I0.31,7.05),P=0.62]。结论对于符合米兰标准的原发性肝癌,SLT比PLT手术时间更长,术中出血更多,但术后并发症及围术期死亡率两者比较无统计学意义,SLT可以作为治疗肝癌的重要策略,尤其是早期肝癌。【Objective】 To compare the effectiveness and advantage of salvage liver transplantation postresection with primary liver transplantation for HCC patients.【Methods】 Acccording to the including criteria,8 retrospective studies involving 599 patients were included.Rev Man 5.1 software was used for data analysis.【Results】 We conducted subgroup analysis based on outcome measures and interventions.Comparing with PLT,SLT is associated with longer the operative time [WMD =-31.46,95%CI（-59.45,-3.48）,P =0.03],more loss of the volume of blood [WMD =-975.58,95%CI（-1293.99,-657.17）,P 0.0001].Compared to postoperative complications,the incidence of Biliary complications [OR = 0.96,95%CI（0.48,1.91）,P =0.90],retransplantion [OR = 1.17,95%CI（0.44,3.14）,P =0.75],Arterial thrombosis [OR = 0.91,95%CI（0.34,2.39）,P = 0.84],Acute rejection [OR = 0.55,95%CI（0.23,1.31）,P =0.18],Postoperative death [OR = 1.48,95%CI（0.31,7.05）,P =0.62] showed no statistically significant difference between SLT and PLT.【Conclusion】 Salvage liver transplantation strategy still remain satisfactory effective in the treatment of hepatocellular carcinoma,it can be integrated with the treatment strategy for hepatocellular carcinoma patients with tumor meets Milan criteria.

关 键 词：首次肝移植 补救性肝移植 原发性肝癌 系统评价 

分 类 号：R735.7[医药卫生—肿瘤]