腹腔镜与开腹手术切除治疗肝门部胆管癌疗效与安全性的荟萃分析  

Efficacy and safety of laparoscopic versus open radical resection for hilar cholangiocarcinoma: a meta-analysis

作　　者：王春明 谭洪坤 陈锟灵 张成[1] 钟凯航 潘明新 Wang Chunming;Tan Hongkun;Chen Kunling;Zhang Cheng;Zhong Kaihang;Pan Mingxin(Department of Hepatobiliary SurgeryⅡ,Zhujiang Hospital,Southern Medical University,Guangzhou 510280,China)

机构地区：[1]南方医科大学珠江医院肝胆二科,广州510280

出　　处：《中华肝胆外科杂志》2022年第2期133-138,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金面上项目(82072627)。

摘　　要：目的系统评价腹腔镜与开腹手术切除治疗肝门部胆管癌的安全性、可行性及近期疗效。方法检索的数据库包括PubMed、EMbase、Cochrane图书馆、Web of Science、中国知网中文数据库、万方医学网、维普、中国生物医学文献数据库,检索日期范围为从建库至2021年11月30日。对纳入研究的文献进行质量评价及资料提取,采用RevMan 5.4软件对提取的资料进行荟萃分析。结果共纳入12篇文献,均为病例对照研究,包含634例患者,其中行腹腔镜下肝门部胆管癌根治术者275例为腹腔镜组,行开腹肝门部胆管癌根治性切除术者359例为开腹组。荟萃分析结果显示,与开腹组相比,腹腔镜组的手术时间(MD=58.36,95%CI:13.54~103.18)增加,而术中出血量(MD=-79.70,95%CI:-90.01~-69.39)、住院时间(MD=-3.37,95%CI:-4.29~-2.45)及切口相关并发症发生率(OR=0.36,95%CI:0.16~0.80)均降低,差异具有统计学意义(P<0.05)。两组的淋巴结清扫数目、R0切除率、术后胆瘘发生率、腹腔感染发生率、总的并发症发生率、围术期死亡率及术后1年生存率间差异无统计学意义(P>0.05)。结论在手术经验丰富的肝胆外科中心,通过合理选择病例,开展腹腔镜下肝门部胆管癌根治术是可行和安全的。Objective This article aimed to systematically evaluate the safety,feasibility and short-term outcomes of laparoscopic versus open radical resection for hilar cholangiocarcinoma.Methods Relevant medical literatures published before November 30,2021 were searched using PubMed,EMbase,Cochrane Library,Web of Science,CNKI,Wanfang,VIP,CBM databases.Based on predetermined inclusion and exclusion criteria,articles were selected,and RevMan5.4 software was used to conduct the meta-analysis of this study.Results Twelve comparative cohort articles were enrolled,which included 634 patients.There were 275 patients who underwent laparoscopic radical resection for hilar cholangiocarcinoma in the laparoscopic group,and 359 patients who underwent open radical resection for hilar cholangiocarcinoma in the open group.Meta-analysis showed that when compared with the open group,operation time of the laparoscopic group was significantly longer(MD=58.36,95%CI:13.54-103.18).However,intraoperative blood loss(MD=-79.70,95%CI:-90.01--69.39),hospital stay(MD=-3.37,95%CI:-4.29--2.45)and incision-related complications(OR=0.36,95%CI:0.16-0.80)were all significantly less(all P<0.05).The number of lymph node harvested,R0 resection rates,postoperative bile leakage,intraperitoneal infection and effusion,total complication rates,and perioperative mortality and 1-year survival rates after operation between the two groups were not significantly different(all P>0.05).Conclusion Laparoscopic radical resection for hilar cholangiocarcinoma was feasible and safe in selected patients carried out in an experienced hepatobiliary surgery center.

关 键 词：Klatskin肿瘤 腹腔镜检查 META分析 开腹手术 

分 类 号：R735.8[医药卫生—肿瘤]