原发性肝癌合并脾功能亢进外科治疗的Meta分析  

Surgical treatments of hepatocellular carcinoma with hypersplenism： a meta-analysis

作　　者：沈艺南 杨田[1] 张汉[1] 魏勇鹏[1] 王舟翀[1] 施洋[1] 卢军华[1] 杨广顺[1] 吴孟超[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院肝外五科,上海200438

出　　处：《腹部外科》2014年第4期304-309,共6页Journal of Abdominal Surgery

基　　金：国家自然科学基金资助项目（81000166,81172020,81372262）;上海市科委青年科技启明星计划（12QA1404800）;上海市卫生系统优秀人才培养计划（XYQ2011033）;第二军医大学优秀青年学者计划（QNXZ2013220）;上海市慈善癌症研究中心慈善慢跑课题（SHCS2013120）.

摘　　要：目的比较肝脾联合切除术与单纯肝癌切除术在治疗原发性肝癌合并脾功能亢进的围手术期并发症发生率和死亡率、术后生存率方面有无明显差异。方法计算机检索PubMed、Em—base、CochraneLibrary、中国期刊全文数据库、中国生物医学文献数据库、数字化期刊全文数据库以及中文科技期刊全文数据库，同时根据以上检索所得文献的参考文献进行扩大检索。使用改良Sackett’S分级法进行质量评价，采用Cochrane协作网提供的RevMan5．2．7统计软件进行Meta分析。结果共纳入8项研究，共计772例患者。结果显示，肝脾联合切除组（HS）与单纯肝癌切除组（H）相比，在围手术期并发症发生率（0R合并=0．90，95％CI=0．63～1．29，P=0．56）、围手术期死亡率（（OR合并=1．04，95％CI=0．3～3．58，P=0．96）、以及5年生存率（ORgy-=1．53，95％CI=0．99～2．36，P=0．05）上差异并无统计学意义。然而，HS组在术后白细胞计数（MD=5．47，95％CI=5．13～5．82，P％0．01）及血小板计数（MD=174．89，95％CI=116．61～233．18，P〈0．01）方面，较H组有显著上升，差异具有统计学意义。结论相对于单纯肝切除而言，肝脾联合切除治疗肝癌合并脾功能亢进在围手术期并发症发生率、死亡率，以及术后5年生存率方面差异无统计学意义。然而HS组在术后白细胞及血小板得到显著回升，这可能有利于患者术后免疫功能的恢复和后续的化疗。Objective To evaluate the clinical efficacy and safety of concurrent hepatectomy and splenectomy （HS） versus hepatectomy （H） alone for hepatocellular carcinoma complicated with hepat- ic cirrhosis and hypersplenism. Methods The relevant literatures were retrieved from the databases of PubMed, EMbase, Cochrane Library, Chinese Journal Full-text Database, Chinese Biomedical Litera- ture Database, Chinese Vip Database and Chinese Wanfang. And exploding searches were conducted with the references of retrieved articles. The quality of eligible trials was assessed by the SackettJs method. And the Review Manager software （Version 5.2. 7） was used for statistical analyses. Results Eight studies were retrieved with a total of 772 patients. Meta-analysis showed that no significant difference existed in perioperative morbidities （OR = 0. 90, 95% CI = 0. 63-1.29, P = 0. 56）, perioperative mortalities （OR = 1.04, 95%CI = 0. 3-3. 58, P = 0. 96） or 5-year survival rates （OR = 1.53, 95%CI= 0. 99-2. 36, P = 0. 05）. While white blood cell count （MD = 5. 47, 95%CI = 5. 13-5.82, P〈0. 01） and platelet count （MD = 174. 89, 95%CI = 116. 61-233. 18, P〈0. 01） were significantly elrvated in patients undergoing concurrent hepatosplenectomy. Conclusions Comparing with hepatectomy alone, concurrent hepatosplenectomy demonstrates no better perioperative morbidities, mortalities or 5-year survival rates in patients hepatocellular carcinoma with hypersplenism. And elevated white blood cell and platelet count in patients undergoing concurrent surgical modalities may provide benefits of immune functions and subsequent chemotherapy.

关 键 词：肝细胞癌 肝硬化 脾功能亢进 肝脾联合切除 META分析 

分 类 号：R657.34[医药卫生—外科学]