腹腔镜肝门部胆管癌根治术有效性与安全性的Meta分析  

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

作　　者：龚德胜 孙超 李宣良 柳韩 闫雯 高本见 李波 GONG Desheng;SUN Chao;LI Xuanliang(Department of General Surgery,Longquan Hospital of Chengdu University of Traditional Chinese Medicine,the Traditional Chinese Medicine Hospital of Longquan,Chengdu 610083,China;Department of General Surgery,Pujiang Hospital of Sichuan Provincial People's Hospital,Pujiang People's Hospital)

机构地区：[1]成都中医药大学附属医院龙泉医院,龙泉驿区中医医院普通外科,四川成都610083 [2]四川省人民医院蒲江医院,蒲江县人民医院普通外科 [3]西南医科大学附属医院肝胆胰外科

出　　处：《腹腔镜外科杂志》2024年第4期245-255,共11页Journal of Laparoscopic Surgery

基　　金：四川省科技厅重点研发项目(22ZDYF1898)。

摘　　要：目的:系统评价腹腔镜手术(LS)与开腹手术(OS)治疗肝门部胆管癌的临床效果与安全性。方法:检索中、英文数据库关于LS与OS治疗肝门部胆管癌的临床对照研究,检索时间截至2023年7月。对纳入的研究进行质量评价与数据提取,采用RevMan 5.3软件进行Meta分析。结果:共纳入17项研究、905例患者,其中LS组380例,OS组525例。结果显示,与OS组相比,LS组手术时间长(MD=74.25,95%CI:56.14~92.36,P<0.00001),术中出血量少(MD=-93.31,95%CI=-127.64~-58.97,P<0.00001),输血率低(OR=0.51,95%CI=0.32~0.82,P=0.006),R0切除率高(OR=2.14,95%CI=1.30~3.53,P=0.003),术后总体并发症发生率低(OR=0.64,95%CI=0.44~0.93,P=0.02),术后住院时间短(MD=-3.63,95%CI=-4.67~-2.60,P<0.00001)。两组淋巴结清扫数量、胆漏发生率、腹腔出血率、肝功能衰竭发生率、切口感染率、围手术期死亡率及1年、2年总体生存率差异均无统计学意义(P>0.05)。结论:基于病例选择及术前充分评估,腹腔镜肝门部胆管癌根治术是安全、可行的,并具有一定的微创优势,在有经验的中心可进一步应用。Objective:To systematically evaluate the clinical efficacy and safety of laparoscopic surgery(LS)and open surgery(OS)in the treatment of hilar cholangiocarcinoma(HCCA).Methods:The controlled studies comparing LS and OS in the treatment of HCCA in English and Chinese databases were searched.The retrieval time was up to Jul.2023.After quality evaluation and data extraction of the included studies,meta-analysis was performed using RevMan 5.3 software.Results:A total of 905 patients were included in 17 studies,with 380 in the LS group and 525 in the OS group.The results showed that compared with the OS group,although operation time was significantly longer(MD=74.25,95%CI=56.14~92.36,P<0.00001)in the LS group,the LS group was associated with significantly less intraoperative blood loss(MD=-93.31,95%CI=-127.64~-58.97,P<0.00001),lower blood transfusion rate(OR=0.51,95%CI=0.32~0.82,P=0.006),higher R0 resection rate(OR=2.14,95%CI=1.30~3.53,P=0.003),lower incidence of overall postoperative complications(OR=0.64,95%CI=0.44~0.93,P=0.02),and shorter postoperative hospital stay(MD=-3.63,95%CI=-4.67~-2.60,P<0.00001).There were no significant differences between the two groups in the number of lymph nodes harvested,bile leakage rate,intra-abdominal bleeding rate,hepatic failure rate,incision infection rate,perioperative mortality,and 1-year and 2-year overall survival rates(P>0.05).Conclusions:Based on case selection and adequate preoperative evaluation,laparoscopic radical resection of HCCA is safe and feasible,with certain minimally invasive advantages,and its application can be considered more in experienced centers.

关 键 词：肝门部胆管癌 腹腔镜检查 剖腹术 根治性切除术 META分析 

分 类 号：R657.4[医药卫生—外科学]