腹腔镜技术在活体肝移植供肝获取中应用价值的评价  

Laparoscopic living donor hepatectomy in living donor liver transplantation：a Meta-analysis

作　　者：李宁[1] 林帆[1] 温敏杰[1] 朱光辉[1] 古维立[1] 曹杰[1] 

机构地区：[1]广州市第一人民医院肝胆外科,510180

出　　处：《中华肝胆外科杂志》2016年第5期299-303,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金（81400679）;广东省基础与应用基础研究专项资金项目（2014A030310067）;广东省医学科研基金（B2014340）

摘　　要：目的评价腹腔镜技术在活体肝移植供肝获取中的应用价值。方法系统检索Medline-Pubmed、Embase、Cochranelibrary、GoogleScholar、CNKI等数据库中关于腹腔镜技术与传统开腹方法用于活体肝移植供肝切除的对照研究。提取的目标数据采用软件RevMan5．0进行统计分析。结果10项研究共计1059例活体供肝切除术纳入此次分析。结果显示：（1）供者围手术期情况：与传统开腹比较，腹腔镜组供体术中出血显著减少[SMD=-0．39，95％CI（-0．73，-0．05），P〈0．05]，术后总胆红素峰值水平显著降低[SMD=-0．24，95％CI（-0．47，-0．01），P〈0．05]。供者手术时间显著长于对照组[SMD=0．50，95％CI（0．04，0．96），P〈0．05]。两组术后总体并发症、住院时间、住院费用差异无统计学意义（P〉0．05）。亚组分析显示完全腹腔镜亚组和左肝外叶亚组供者住院时间明显缩短（均P〈0．05）；（2）供肝质量：两组在供肝大小和供肝冷热缺血时间上差异无统计学意义（P〉0．05）；（3）受者预后：两组在术后肝功能峰值水平及并发症发生率上差异均无统计学意义（P〉0．05）。结论腹腔镜技术用于活体肝移植供肝获取手术安全，对供肝质量以及受者预后无明显影响，而且具有供者术中出血量少、术后总胆红素峰值水平低、住院时间短等潜在优势。Objective To systematically evaluate the role of laparoscopic living donor hepatectomy in living donor liver transplantation （LDLT）. Methods A systematic literature search was conducted on Medline-Pubmed, Embase, Cochrane Library to find studies on laparoseopic living donor hepatectomy for LDLT. All extracted data were analyzed using the RevMan 5 software. Results Ten studies with a total of 1 059 participants were included in this analysis. Laparoscopic donor hepatecomy （ LDH ） was associated with significantly less intraoperative blood loss [ SMD = - 0.39, 95% CI （ - 0. 73, - 0. 05 ）, P 〈 0. 05 ], lower peak level of postoperative total bilirubin [ SMD = - 0.24, 95% CI （ - 0. 47, - 0. 01 ）, P 〈 0.05 and longer operative time [SMD =0.50,95% CI （0. 04,0. 96）, P 〈0. 051 when compared with those oper- ated with open surgery. On subgroup analyses, hospitalization stay decreased in patients who underwent LDLT with grafts obtained by complete living donor hepatectomy （LDH） and left lateral sectionectomy （ both P 〈 0. 05 ）. LDH was comparable to open surgery in donor complication rates and in-hospital cost （ P 〉 0. 05 ）. There were no differences on the harvested liver graft size, ischemic time, recipient postoperative liver function and complications between the two groups （ P 〉 0.05 ）. Conclusions Laparoscopic hepateetomy in living donor is a safe procedure for graft-harvesting, which improved the clinical outcomes of the donor, liver graft and recipient in LDLT. It has also the advantages of reduced blood loss, low peak levels of postoperative total bilirubin and short hospitalization stay.

关 键 词：活体肝移植 腹腔镜 安全性 并发症 META分析 

分 类 号：R657.3[医药卫生—外科学]