精准肝切除治疗原发性肝癌近期疗效的Meta分析  

Short-term efficacy of precise hepatectomy for primary liver cancer: a Meta-analysis

作　　者：王新青[1] 卜阳[2] 于松宁[2] 张光华[1] 胡洋[1] 张朋飞[1] 

机构地区：[1]宁夏医科大学研究生院,宁夏银川750004 [2]宁夏医科大学总医院肝胆外科,宁夏银川750004

出　　处：《中国普通外科杂志》2016年第1期57-67,共11页China Journal of General Surgery

基　　金：宁夏科技攻关资助项目(2012/01-2015/12)

摘　　要：目的:系统性评价精准肝切除治疗原发性肝癌的近期疗效。方法:检索国内外数据库,收集有关比较精准肝切除与常规肝切除治疗原发性肝癌疗效的随机对照试验(RCT)与临床对照试验(CCT)。按纳入标准筛选后进行质量评分,提取数据,采用Rev Man 5.3软件行Meta分析。结果:共纳入了6个RCT及9个CCT,其中患者1 367例,精准肝切除术685例(精准组),传统肝切除术682例(对照组)。Meta分析结果显示,与对照组比较,精准组术中出血量、围手术期输血量、住院时间减少,但手术时间延长(MD=-175.45,95%CI=-234.37^-116.53;MD=-311.04,95%CI=-444.53^-177.55;MD=-3.11,95%CI=-4.36^-1.87;MD=31.72,95%CI=12.00~51.44,均P<0.05);肿瘤完整切除率提高(OR=0.18,95%CI=0.07~0.45,P=0.0003);肝功能恢复加快(ALT:M D=-81.75,95%C I=-109.50^-54.00;AST:M D=-67.27,95%C I=-94.36^-40.18;TBIL:M D=-4.54,95%CI=-7.33^-1.75;ALB:MD=3.75,95%CI=0.54~6.97,均P<0.05);并发症发生率减少(OR=0.24,95%CI=0.17~0.35,P<0.05);1年复发率降低、1年生存率提高(OR=0.56,95%CI=0.37~0.85;OR=1.61,95%CI=1.01~2.57,均P<0.05)。结论:精准肝切除治疗原发性肝癌较常规肝切除创伤小、恢复快,且近期预后好。Objective： To systematically evaluate the short-term clinical efficacy of precise hepatectomy in treatment of primary liver cancer. Methods： The randomized controlled trials （RCTs） and clinical controlled trials （CCTs） comparing precise hepatectomy and conventional hepatectomy for primary liver cancer were collected by searching several national and international databases. After screening for inclusion, quality assessment and data extraction, Meta-analysis was performed by the RevMan 5.3 software.Results： Six RCTs and 9 CCTs were finally included, with total of 1 367 patients, of whom 685 cases underwent precise hepatectomy （precise group） and 682 cases were subjected to conventional hepatectomy （control group）. Results of the Meta-analysis showed that in precise group compared with control group, the intraoperative blood loss, perioperative blood transfusion and length of hospital stay were reduced, but the operative time was prolonged （MD=-175.45, 95% CI=-234.37--116.53; MD=-311.04, 95% CI=-444.53--177.55; MD=-3.11, 95% CI=-4.36--1.87; MD=31.72, 95% CI=12.00-51.44, all P〈0.05）, the complete resection rate was improved （OR=0.18, 95% CI=0.07-0.45, P=0.0003）, recover of liver function was accelerated （ALT： MD=-81.75, 95% CI=-109.50--54.00; AST： MD=-67.27, 95% CI=-94.36-40.18; TBIL： MD=-4.54, 95% CI=-7.33-1.75; ALB： MD=3.75, 95% CI=0.54-6.97, all P〈0.05）, and the incidence of complications was decreased （OR=0.24, 95% CI=0.17-0.35, P〈0.05）. The 1-year recurrence rate was decreased and 1-year survival rate was increased （OR=0.56, 95% CI=0.37-0.85; OR=1.61, 95% CI=1.01-2.57, both P〈0.05）. Conclusion： Precise hepatectomy results in less trauma, quicker recovery and better short-term outcomes than the conventional method in treatment of primary liver cancer.

关 键 词：肝切除术/方法 肝肿瘤 精准肝切除 META分析 

分 类 号：R657.3[医药卫生—外科学]