肝门部胆管癌根治手术中联合血管切除及重建的临床疗效Meta分析  

Meta-analysis of clinical efficacy of combined vascular resection plus reconstruction in radical resection of hilar cholangiocarcinoma

作　　者：郭敏[1] 魏凡 商中华[1] GUO Min;WEI Fan;SHANG Zhonghua(Department of General Surgery,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Department ofGastroenterology,Jilin University Sino-Japanese Friendship Hospital,Changchun 130033,China)

机构地区：[1]山西医科大学第二医院普通外科,山西太原030001 [2]吉林大学中日联谊医院消化内科,吉林长春130033

出　　处：《中国普通外科杂志》2020年第8期924-935,共12页China Journal of General Surgery

基　　金：山西省自然科学基金资助项目(201801D121217)。

摘　　要：背景与目的:对于肝门部胆管癌(HCCA)而言,血管侵犯是主要的手术治疗障碍之一。联合血管切除及重建后的各个临床研究指标不一,结论也存在一定的争议,本研究通过Meta分析方法系统评价HCCA根治术中联合血管切除及重建的安全性、切除有效性及近远期疗效。方法:检索多个国内外数据库,收集HCCA根治术中联合血管切除及重建与无血管切除比较的研究,前者包括肝动脉切除及重建和门静脉切除及重建,检索起止时间均为2009年1月1日—2019年1月1日。采用Meta分析方法比较两种术式的安全性、根治效果及近远期疗效指标。结果:最终纳入18篇文献(均为回顾性研究),共3 260例患者,其中行联合血管切除及重建904例(血管切除组),未行血管切除2 356例(对照组);分亚组的研究中含肝动脉切除及重建237例(肝动脉切除亚组)与门静脉切除及重建560(门静脉切除亚组)。Meta分析结果显示,与对照组比较,血管切除组的术后总并发症(OR=1.09,95% CI=0.78~1.54,P=0.61)、肝衰竭(OR=0.84,95% CI=0.56~1.24,P=0.36)的发生率均无明显差异,但血管并发症(OR=6.79,95% CI=2.16~21.38,P=0.01)与肝脓肿(OR=7.47,95% CI=2.63~21.18,P=0.01)的发生率升高;术后病死率无统计学差异(OR=1.27,95% CI=0.84~1.93,P=0.25);术后1、3、5年的总体生存率差异均有统计学差异(OR=0.69,95% CI=0.56~0.85;OR=0.62,95% CI=0.52~0.75;OR=0.61,95% CI=0.49~0.76,均P<0.05);R0切除率无统计学差异(OR=0.96,95% CI=0.66~1.40,P=0.84)。亚组分析显示,肝动脉切除亚组和门静脉切除亚组与对照组总并发症发生率均无统计学差异(均P>0.05);肝动脉切除亚组的5年总生存率低于对照组(OR=0.44,95% CI=0.30~0.67,P=0.01),但门静脉切除亚组的5年总生存率与对照组无明显差异(OR=0.89,95% CI=0.68~1.17,P=0.42)。此外,R0切除组患者5年生存率高于R1切除组,无淋巴结转移患者5年生存率高于有淋巴结转移患者(均P<0.05)。结论:HCCA根治术中Background and Aims:For hilar cholangiocarcinoma (HCCA),vascular invasion is one of the major surgical obstacles.The observed variables were varied in different clinical studies on combined vascular resection and reconstruction,which generated mixed conclusions.This study was conducted to systematically evaluated the safety,efficacy and short-and long-term efficacy of combined vascular resection plus reconstruction during radical resection of HCCA by Meta-analysis.Methods:The studies comparing the radical resection of HCCA combined with vascular resection plus reconstruction and without vascular resection,the former includes hepatic artery resection plus reconstruction and portal vein resection plus reconstruction,were searched in several national and international databases.The retrieval time was defined between January 1,2009 to January 1,2019.The clinical variables associated to the safety,radical effectiveness and short-and long-term efficacy od the two surgical types were compared by Meta-analysis.Results:Eighteen studies were finally included (all were retrospective studies),involving a total of 3 260 patients,with 904 cases undergoing vascular resection plus reconstruction (vascular resection group) and 2 356 without vascular resection (control group).In studies defined subgroups containing 237 cases undergoing hepatic artery resection plus reconstruction (hepatic artery resection subgroup) and 560 cases undergoing portal vein resection plus reconstruction (portal vein resection subgroup).The results of Meta-analysis showed that in vascular resection group compared with control group,the incidence rates of overall postoperative complications (OR=1.09,95% CI=0.78–1.54,P=0.61) and liver failure (OR=0.84,95% CI=0.56–1.24,P=0.36) had no significant difference,but the incidence rates vascular complications (OR=6.79,95% CI=2.16–21.38,P=0.01) and liver abscess (OR=7.47,95% CI=2.63–21.18,P=0.01) were increased;the postoperative mortality had no significant difference (OR=1.27,95% CI=0.84–1.93,P=0.25);the

关 键 词：Klatskin肿瘤 血管切除术 血管重建术 META分析 

分 类 号：R735.8[医药卫生—肿瘤]