肝门部胆管癌根治术联合血管切除重建术治疗肝门部胆管癌的荟萃分析  

Radical resection combined with vascular resection plus reconstruction in treatment of hilar cholangiocarcinoma:A meta-analysis

作　　者：环韵峰 陈轶晖 何凯 王学军 胡晟 廖周俊 张小文[1] Huan Yunfeng;Chen Yihui;He Kai;Wang Xuejun;Hu Sheng;Liao Zhoujun;Zhang Xiaowen(Department of Hepatobiliary and Pancreatic Surgery,the Second Affiliated Hospital of Kunming MedicalUniversity,Kunming 650106,China)

机构地区：[1]昆明医科大学第二附属医院肝胆胰外科,云南昆明650106

出　　处：《实用肿瘤杂志》2023年第2期161-172,共12页Journal of Practical Oncology

摘　　要：目的 用荟萃分析的方法评价肝门部胆管癌根治术联合血管切除重建术除治疗肝门部胆管癌的围术期安全性和远期疗效。方法 计算机检索PubMed、Web of Science、Embase、Cochrane library、中国生物医学文献数据库、中国知网和万方数据库关于联合血管切除重建与不切除血管根治性切除治疗肝门部胆管癌的临床对照研究,检索时间限定为2010年1月1日至2021年3月1日。对纳入的文献数据采用RevMan 5.3进行分析,比较两种治疗方法的安全性和有效性。结果 共纳入21篇文献(均为回顾性研究),共4 124例患者,血管切除重建组1283例,包括门静脉切除重建组718例、肝动脉切除重建组302例和联合切除重建组263例,未切除组2841例。血管切除重建组与未切除组在术后总体并发症(OR=1.16,95%CI:0.98~1.37,P=0.08)、术中失血量(MD=150.92,95%CI:-9.19~311.04,P=0.06)、术后死亡率(OR=1.37,95%CI:0.97~1.93,P=0.07)和术后复发率(OR=0.78,95%CI:0.37~1.64,P=0.52)等方面比较,差异均无统计学意义;在术后1、3和5年生存率(OR=0.68,95%CI:0.51~0.90,P<0.01;OR=0.62,95%CI:0.50~0.75,P<0.01;OR=0.54,95%CI:0.43~0.68,P<0.01)和R0切除率(OR=0.63,95%CI:0.52~0.76,P<0.01)方面,血管切除重建组均小于未切除组。门静脉和肝动脉切除重建组亚组的5年生存率(OR=0.51,95%CI:0.36~0.73,P<0.01;OR=0.55,95%CI:0.39~0.76,P<0.01)均小于未切除组;肝动脉切除重建亚组术后死亡率(OR=1.89,95%CI:1.04~3.42,P=0.04)大于未切除组。血管切除重建组肝功能衰竭发生率(OR=1.91,95%CI:1.09~3.36,P=0.02)大于未切除组。结论 肝门部胆管癌根治术联合血管切除重建术治疗肝门部胆管癌总体上来说是安全的,联合血管切除重建的术式可以改善局部进展期患者预后,延长患者生存期,有肝门血管侵犯的肝门部胆管癌不应是手术的禁忌证。Objective To evaluate the perioperative safety and long-term efficacy of radical resection combined with vascular resec-tion plus reconstruction in the treatment of hilar cholangiocarcinoma by meta-analysis.Methods The clinical controlled study of radical resection of hilar cholangiocarcinoma combined with vascular resection plus reconstruction and without vascular resection was searched from PubMed、Web of Science、Embase、Cochrane library、China Biology Medicine disc(SinoMed CBM),China National Knowledge Infrastructure(CNKI)and Wangfang databases.The retrieval time was limited to January 1st,2010-March 1st,2021.The included literature data were analyzed by RevMan 5.3 to compare the safety and effectiveness of the two treatment methods.Results A total of 21 literatures(all retrospective studies)were included,involving 4124 patients,including 1283 patients in the vascular resection plus reconstruction group(718 patients in the portal vein resection and reconstruction group,302 patients in the hepatic artery resection and reconstruction group,and 263 patients in the combined resection and reconstruction group),and 2841 patients in the unresected group.Compared the vascular resection and reconstruction group with the unresected group,the overall postoperative complications(OR=1.16,95%CI:0.98-1.37,P=0.08),intraoperative blood loss(MD=150.92,95%CI:-9.19-311.04,P=0.06),postoperative mortality(OR=1.37,95%CI:0.97-1.93,P=0.07)and postoperative recurrence rate(OR=0.78,95%CI:0.37-1.64,P=0.52)had no significant difference.The postoperative 1-,3-and 5-year survival rates(OR=0.68,95%CI:0.51-0.90,P<0.01;OR=0.62,95%CI:0.50-0.75,P<0.01;OR=0.54,95%CI:0.43-0.68,P<0.01)and R0 resection rates(OR=0.63,95%CI:0.52-0.76,P<0.01)were lower in the vascular resection and reconstruction group than in the unresected group.The 5-year survival rate of the portal vein and hepatic artery resection and reconstruction subgroups(OR=0.51,95%CI:0.36-0.73,P<0.01;OR=0.55,95%CI:0.39-0.76,P<0.01)were both lower than that of the unresected group,and th

关 键 词：肝门部胆管癌 肝门部胆管癌根治术 血管切除重建术 荟萃分析 

分 类 号：R735.8[医药卫生—肿瘤]