联合门静脉切除及重建治疗肝门部胆管癌临床疗效的Meta分析  

Clinical efficacy of combined portal vein resection and construction in the treatment of hilar cholangiocar- cinoma： A Meta-analysis

作　　者：余安 黄强 刘臣海 林先盛 谢放 

机构地区：[1]安徽医科大学附属省立医院普通外科肝胆胰安徽省重点实验室,合肥230001

出　　处：《中华消化外科杂志》2017年第1期65-70,共6页Chinese Journal of Digestive Surgery

基　　金：安徽省自然科学基金项目（1408085QH188）;安徽省科技计划项目（1506c085018）

摘　　要：目的：系统评价肝门部胆管癌切除术中联合门静脉切除及重建的安全性及有效性。 方法：以“hilar cholangiocarcinoma”“Klatskin tumor”“Bile duct neoplasm”“Vascular resection”“portal vein resection”“肝门部胆管癌”“血管切除”“门静脉切除”为检索词，检索Cochrane Library、PubMed数据库、Embase数据库、中国生物医学数据库、中国知网、万方数据库、维普中文科技期刊数据库。检索期限为2006年1月 31日至2016年1月31日。纳入比较肝门部胆管癌切除术中联合门静脉切除及重建和无血管切除及重建临床疗效的研究，由2位文献评价者独立筛查文献和提取数据，并进行文献质量评价。肝门部胆管癌切除术联合门静脉切除重建设为门静脉切除组，未行血管切除设为无血管切除组。分析指标：（1）文献检索结果。（2）Meta分析结果：①术后并发症发生率（肝衰竭、胆瘘、腹腔出血）。②术后病死率。③患者的预后情况。④术后病理学相关指标（淋巴结转移率、中低分化率、神经侵犯率、切缘阴性率）。采用I2对异质性进行分析。采用HR及其95%可信区间（95%CI）为效应量作为预后评价指标；并发症发生率、病死率及病理学特征的评价采用OR及其95%CI表示。 结果：（1）文献检索结果：最终13篇文献纳入研究，均为回顾性研究，累计样本量为1 668例，其中门静脉切除组437例，无血管切除组1 231例。（2） Meta分析结果：①术后并发症发生率：门静脉切除组和无血管切除组患者术后并发症总发生率分别为39.86%、35.27%，两组比较，差异无统计学意义（OR=1.12，95%CI：0.82～1.53，P〉0.05）。进一步亚组分析结果表明：门静脉切除组和无血管切除组患者术后主要并发症为肝衰竭、胆瘘及腹腔出血，其发生率分别为17.09%、8.79%、6.25%和10.62%、9.69%、2.51%，两组患者上述指标比较，Objective：To systematically evaluate the safety and effectiveness of combined portal vein resection and reconstruction in the resection of hilar cholangiocarcinoma. Methods：Literatures were researched using Cochrane Library, PubMed, Embase, China Biology Medicine disc, China National Knowledge Infrastructure,Wanfang database, VIP database from January 31, 2006 to January 31, 2016 with the key words including ＂hilar cholangiocarcinoma＂ ＂Klatskin tumor＂ ＂Bile duct neoplasm＂ ＂Vascular resection＂ ＂portal vein resection＂ ＂肝门部胆管癌＂ ＂血管切除＂ ＂门静脉切除＂. The clinical studies of resection of hilar cholangiocarcinoma with portal vein resection and construction and without vascular resection and construction were received and enrolled. Two reviewers independently screened literatures, extracted data and assessed the risk of bias. Patients who underwent resection of hilar cholangiocarcinoma combined with portal vein resection and reconstruction were allocated into the portal vein resection group and patients who didn′t undergo vascular resection were allocated into the no vascular resection group. Analysis indicators included （1） results of literature retrieval; （2） results of Metaanalysis： ① incidence of postoperative complications （hepatic failure, biliary fistula, intraabdominal hemorrhage）, ② postoperative mortality, ③ patients′ prognosis, ④ related indicators of postoperative pathology （lymph node metastasis rate, moderate and lowdifferentiated rate, nerve invasion rate, negative rate of resection margin）. The heterogeneity of the studies was analyzed using the I2 test. The hazard ratio （HR） and 95% confidence interval （CI） were used for assessing the prognostic indicators. The incidence of complications, mortality and pathological indicators were evaluated by the odds ratio （OR） and 95%CI. Results：（1） Results of literature retrieval： 13 retrospective studies were enrolled in the metaanalysis, and the total

关 键 词：胆道肿瘤 肝门部 门静脉切除 META分析 

分 类 号：R735.8[医药卫生—肿瘤]