扩大右半肝与全肝移植的疗效与安全性比较Meta分析  

Meta⁃analysis of the efficacy and safety of extended right liver transplantation versus wholeliver transplantation

作　　者：孙江波 潘胜辉 陈维佳 徐剑 SUN Jiang-bo;PAN Sheng-hui;CHEN Wei-jia;XU Jian(Department of Organ Transplantation,the Second Affiliated Hospital of Hainan Medical University,Haikou 570105,China;Hainan Organ Transplantion Institute,Haikou 570105,China)

机构地区：[1]海南医学院第二附属医院器官移植科,海南海口570105 [2]海南省器官移植研究所,海南海口570105

出　　处：《海南医学院学报》2023年第12期928-941,共14页Journal of Hainan Medical University

基　　金：海南省重大科技计划项目(ZDK2019009);海南省临床医学中心建设资助项目(器官移植)。

摘　　要：目的:比较扩大右半肝移植(extended right liver transplantation,ERLT)与全肝移植(whole liver transplantation, WLT)在术后生存率和并发症方面的差异。方法:检索中英文数据库从建库至2022年04月15日收录的关于对比ERLT与WLT治疗终末期肝病的临床研究,对合格文献进行术后并发症及生存率数据提取,获得数据采用Review Manager 5.3进行Meta分析。结果:研究按照制定的检索方式检索出文献共计1 349篇,最终共获得20项符合纳入标准且质量评价合格的文献,涉及1 304例ERLT和9 070例WLT患者。与WLT相比,ERLT术后胆道并发症[OR=1.77,95%CI=(1.39, 2.25),P<0.000 01]、胆漏[OR=2.16,95%CI=(1.64, 2.84),P<0.000 1]、血管总并发症[OR=2.00,95%CI=(1.48, 2.70),P<0.000 1]、肝动脉血栓[OR=2.06,95%CI=(1.50, 2.83),P<0.000 01]、再次肝移植[OR=1.93,95%CI=(1.53,2.45),P<0.000 01]方面发生率更高,而在胆道狭窄[OR=0.74,95%CI=(0.48, 1.15),P=0.18]门静脉血栓[OR=1.72,95%CI=(0.84, 3.49),P=0.14]移植肝原发性无功能[OR=1.27,95%CI=(0.80, 2.02),P=0.32]方面发生率无显著差异;在生存率方面,ERLT的1年移植肝存活率[OR=0.64,95%CI=(0.54,0.76),P<0.000 01]及患者生存率[OR=0.75,95%CI=(0.62, 0.91),P=0.003]与WLT相比更高,而在5年移植肝存活率[OR=0.97,95%CI=(0.76, 1.23),P=0.78]和5年患者生存率[OR=0.94,95%CI=(0.78, 1.14),P=0.54]无显著差异。上述指标经敏感性分析和发表偏倚检验,未发现单篇较大的异质性和发表偏倚。结论:ERLT能够安全有效的治疗成人终末期肝病,术后并发症及生存情况与WLT相当。and content,after which NOS quality evaluation was performed for literature that matched the study.Postoperative complications and survival data were extract-ed from the eligible literature and subjected to Meta-analysis with Review Manager 5.3,and finally data sensitivity analysis and publication bias tests were performed.Results:The complication of ERLT such as biliary complications[OR=1.77,95%CI=(1.39,2.25),P<0.00001],biliary leakage[OR=2.16,95%CI=(1.64,2.84),P<0.0001],total vascular complications[OR=2.00,95%CI=(1.48,2.70),P<0.0001],hepatic arterial thrombosis[OR=2.06,95%CI=(1.50,2.83),P<0.00001],re-Transplantation[OR=1.93,95%CI=(1.53,2.45),P<0.00001]have a higher occurrence rate compared with WLT.While the biliary stenosis[OR=0.74,95%CI=(0.48,1.15),P=0.18],hepatic portal vein thrombosis[OR=1.72,95%CI=(0.84,3.49),P=0.14],primary non-function[OR=1.27,95%CI=(0.80,2.02),P=0.32]had no statistically difference in the inci-dence of complications after liver transplantation.In terms of survival,ERLT had lower 1-year graft survival rate[OR=0.64,95%CI=(0.54,0.76),P<0.00001]and patient survival rate[OR=0.75,95%CI=(0.62,0.91),P=0.003]than WLT.Fortu-nately,there was no statistically difference in 5-year graft survival rate[OR=0.97,95%CI=(0.76,1.23),P=0.78]and 5-year patient survival rate[OR=0.94,95%CI=(0.78,1.14),P=0.54].Conclusion:ERLT is a safe and effective treatment for adult end-stage liver disease.As a surgical method with postoperative complications and survival similar to that of WLT,ERLT can in-crease the source of donor liver.

关 键 词：扩大右半肝移植 肝动脉血栓 原发性无功能 胆道并发症 

分 类 号：R657.3[医药卫生—外科学]