腹腔镜与开腹肝门部胆管癌根治术疗效比较的Meta分析  

Laparoscopic versus open radical resection for hilar cholangiocarcinoma:A Meta-analysis

作　　者：张明雄 郑梦秋 杨荃 王孝槐 张小文[3] ZHANG Mingxiong;ZHENG Mengqiu;YANG Quan;WANG Xiaohuai;ZHANG Xiaowen(Yunnan Cancer Hospital/Yunnan Cancer Center,Yunnan Kunming 650118,China;Neonatal Department,Kunming Maternal and Child Health Hospital,Yunnan Kunming 650031,China;the Second Affiliated Hospital of Kunming Medical University,the Second Ward of Hepatobiliary Pancreatic Surgery,Yunnan Kunming 650032,China)

机构地区：[1]云南省肿瘤医院/云南省癌症中心,云南昆明650118 [2]昆明市妇幼保健院新生儿科,云南昆明650031 [3]昆明医科大学第二附属医院肝胆胰外科二病区,云南昆明650032

出　　处：《现代肿瘤医学》2022年第1期77-84,共8页Journal of Modern Oncology

基　　金：国家自然科学基金资助项目(编号:81760430)。

摘　　要：目的:系统评价腹腔镜肝门部胆管癌根治术(laparoscopic radical resection for hilar cholangiocarcinoma,LRRHC)与开腹肝门部胆管癌根治术(open radical resection for hilar cholangiocarcinoma,ORRHC)两种手术方式的临床疗效。方法:以laparoscopy、laparoscopic、laparotomy、open surgery、bile duct neoplasms、hilar cholangiocarcinoma、腹腔镜手术、开腹手术、胆管癌、肝门部胆管癌为检索词,检索PubMed、Embase、the Cochrane Library、CBM、CNKI、VANFUN数据库。检索时间为1960年01月至2020年12月。根据Cochrane系统评价原则,由两名研究者独立筛选文献并提取数据,进行质量评价后使用Review Manager 5.3版进行统计分析。计量资料采用均数差(MD)及其95%可信区间(95%CI)表示,计数资料采用比值比(OR)及其95%CI表示。采用I^(2)对纳入文献进行异质性分析。纳入研究≥5篇,采用漏斗图检验潜在发表偏倚;纳入研究<5篇,则不检验。结果:文献检索结果:最终纳入符合标准的相关文献8篇。8篇文献累积样本量329例患者,其中LRRHC组160例,ORRHC组169例。Meta分析结果:LRRHC组与ORRHC组手术时间、术中出血量、术后镇痛时间、术后并发症发生率及术后住院时间比较,差异有统计学意义(P<0.05)。LRRHC组与ORRHC组淋巴结清扫数目、R0切除、术后进食时间、术后1年生存率及2年生存率比较,差异无统计学意义(P>0.05)。8篇文献进行漏斗图分析,其结果显示:漏斗图左右对称,表明发表偏倚对Meta分析结果影响较小。结论:在经验丰富的肝胆胰疾病临床医学中心,LRRHC在肝门部胆管癌的治疗中是安全、可行的。虽然LRRHC的手术时间要长于ORRHC,但与ORRHC相比,LRRHC具有创伤小、术中出血量少、术后镇痛效果好、术后并发症发生率低及住院时间短等特点,而在淋巴结清扫数目、R0切除、术后进食时间、术后1年生存率及术后2年生存率方面与ORRHC无明显差异。Objective:To systematically evaluate the clinic effect of laparoscopic versus open radical resection for hilar cholangiocarcinoma.Methods:Databases including PubMed,EMbase,the Cochrane Library,CBM,CNKI and VANFUN were searched for from January 1960 to December 2020 with the key words including"laparoscopy,laparoscopic,laparotomy,open surgery,bile duct neoplasms,hilar cholangiocarcinoma".Reviewed the literature,extracted the data,and evaluated the quality using the Cochrane systematic review method.The statistical analysis was performed using Review Manager version 5.3.Continuous variables were calculated by the mean differences(MD)with 95%confidence interval(CI),whereas dichotomous variables were calculated by odds ratio(OR)with 95%CI.The heterogeneitv of the studies included was analyzed using the I^(2) test.Funnel plotwas used to testpotential publication bias if the studies included≥5,and no test was needed if the studies included<5.Results:Document retrieval:8 relevant literatures conforming to the standards were included.There were 329 patients,including 160 patients in LRRHC group and 169 patients in ORRHC group.The Meta analysis results LRRHC group had a longer operation time,less intraoperative blood loss,postoperative analgesia,postoperative complications and postoperative hospital stay,the difference was statistically significant(P<0.05).There were no statistically significant differences between the LRRHC group and ORRHC group in the number of lymph node dissection,R0 resection,postoperative feeding time,1-year and 2-year survival rates(>0.05).Funnel plot analysiswas carried out in 8 literatures which shape was symmetrical,indicating that publication bias had little influence on Meta analysis results.Conclusion:LRRHC is safe and feasible in the treatment of hilar cholangiocarcinoma at the experienced clinical medical center for hepatobiliary and pancreatic diseases.Although LRRHC have a longer operation time than ORRHC,but LRRHC had less trauma,less intraoperative blood loss,better postoperative anal

关 键 词：肝门部胆管癌 腹腔镜 开腹手术 根治术 META分析 

分 类 号：R735.7[医药卫生—肿瘤]