目的 系統(tǒng)評(píng)價(jià)腹腔鏡與開(kāi)腹手術(shù)治療肝細(xì)胞癌的療效。
方法 計(jì)算機(jī)檢索PubMed、中國(guó)期刊全文數(shù)據(jù)庫(kù)、萬(wàn)方數(shù)據(jù)庫(kù)、中國(guó)博碩士學(xué)位論文數(shù)據(jù)庫(kù)及中國(guó)重要會(huì)議論文數(shù)據(jù)庫(kù)2000~2011年發(fā)表的有關(guān)腹腔鏡肝切除術(shù)和開(kāi)腹肝切除術(shù)治療肝細(xì)胞癌的相關(guān)文獻(xiàn),采用RevMan 5.0進(jìn)行Meta分析。
結(jié)果 共納入11項(xiàng)臨床對(duì)照試驗(yàn),包括781例患者,其中經(jīng)腹腔鏡手術(shù)治療325例,開(kāi)腹手術(shù)治療456例。Meta分析結(jié)果顯示,與開(kāi)腹手術(shù)相比較,腹腔鏡肝切除術(shù)能明顯縮短手術(shù)時(shí)間〔加權(quán)均數(shù)差值(WMD)=-20.85,95% CI (-29.54,-12.16),P<0.000 01〕,減少術(shù)中出血量〔標(biāo)準(zhǔn)化均數(shù)差值(SMD)=-0.42,95% CI (-0.65,-0.19),P=0.000 4〕,降低術(shù)后并發(fā)癥發(fā)生率〔優(yōu)勢(shì)比(OR)=0.43,95% CI (0.28,0.65),P<0.000 1〕,縮短住院時(shí)間 〔WMD=-4.32,95%CI(-6.29,-2.34),P<0.000 1〕。但術(shù)后復(fù)發(fā)率(P=0.80)和術(shù)后1年總生存率(P=0.98)、3年總生存率(P=0.41)、5年總生存率(P=0.12)以及1年無(wú)瘤生存率(P=0.15)、3年無(wú)瘤生存率(P=0.62)和5年無(wú)瘤生存率(P=0.99)差異均無(wú)統(tǒng)計(jì)學(xué)意義。
結(jié)論 對(duì)于病變位于CouinaudⅡ、Ⅲ、Ⅳ、Ⅴ及Ⅵ段,其直徑小于5cm,并且不影響第一和第二肝門血管的暴露,肝功能在Child B級(jí)以上的肝細(xì)胞癌患者,在條件允許的情況下可優(yōu)先考慮腹腔鏡肝切除術(shù)。
引用本文: 代景友,楊樹(shù)萌,張新晨,吳德全. 腹腔鏡與開(kāi)腹手術(shù)治療肝細(xì)胞癌療效的Meta分析. 中國(guó)普外基礎(chǔ)與臨床雜志, 2013, 20(4): 375-380. doi: 復(fù)制
版權(quán)信息: ?四川大學(xué)華西醫(yī)院華西期刊社《中國(guó)普外基礎(chǔ)與臨床雜志》版權(quán)所有,未經(jīng)授權(quán)不得轉(zhuǎn)載、改編
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12. | 劉一人, 王耀東, 嚴(yán)茂林. 腹腔鏡肝癌切除術(shù)與開(kāi)放手術(shù)的療效分析[J]. 武警醫(yī)學(xué)院學(xué)報(bào), 2011, 20(4): 269-271. |
13. | Lee KF, Chong CN, Wong J, et al. Long-term results of laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma: a case-matched analysis[J]. World J Surg, 2011, 35(10):2268-2274. |
14. | Kim HH, Park EK, Seoung JS, et al. Liver resection for hepatocellular carcinoma:case-matched analysis of laparoscopic versus open resection[J]. J Korean Surg Soc, 2011, 80(6):412-419. |
15. | Truant S, Bouras AF, Hebbar M, et al. Laparoscopic resection vs. open liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease:a case-matched study[J]. Surg Endosc, 2011, 25(11):3668-3677. |
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- 1. Lai EC, Tang CN, Ha JP, et al. Laparoscopic liver resection for hepatocellular carcinoma: ten-year experience in a single center[J]. Arch Surg, 2009, 144(2):143-147.
- 2. Belli G, Fantini C, Belli A, et al. Laparoscopic liver resection for hepatocellular carcinoma in cirrhosis:long-term outcomes[J]. Dig Surg, 2011, 28(2):134-140.
- 3. Chung CD, Lau LL, Ko KL, et al. Laparoscopic liver resection for hepatocellular carcinoma[J]. Asian J Surg, 2010, 33(4):168-172.
- 4. Nguyen KT, Geller DA. Is laparoscopic liver resection safe and comparable to open liver resection for hepatocellular carcinoma?[J]. Ann Surg Oncol, 2009, 16(7):1765-1767.
- 5. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary?[J]. Control Clin Trials, 1996, 17(1):1-12.
- 6. Laurent A, Cherqui D, Lesurtel M, et al. Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease[J]. Arch Surg, 2003, 138(7):763-769.
- 7. Kaneko H, Takagi S, Otsuka Y, et al. Laparoscopic liver resection of hepatocellular carcinoma[J]. Am J Surg, 2005, 189(2):190-194.
- 8. Cai XJ, Yang J, Yu H, et al. Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors[J]. Surg Endosc, 2008, 22(11):2350-2356.
- 9. Belli G, Limongelli P, Fantini C, et al. Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis[J]. Br J Surg, 2009, 96(9): 1041-1048.
- 10. 吳志翀, 沈柏用, 彭承宏, 等. 腹腔鏡與開(kāi)腹肝切除術(shù)治療肝細(xì)胞肝癌的對(duì)照研究[J]. 中華腔鏡外科雜志, 2010, 3(6):507-512.
- 11. Tranchart H, Di Giuro G, Lainas P, et al. Laparoscopic resection for hepatocellular carcinoma:a matched-pair comparative study[J]. Surg Endosc, 2010, 24(5):1170-1176.
- 12. 劉一人, 王耀東, 嚴(yán)茂林. 腹腔鏡肝癌切除術(shù)與開(kāi)放手術(shù)的療效分析[J]. 武警醫(yī)學(xué)院學(xué)報(bào), 2011, 20(4): 269-271.
- 13. Lee KF, Chong CN, Wong J, et al. Long-term results of laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma: a case-matched analysis[J]. World J Surg, 2011, 35(10):2268-2274.
- 14. Kim HH, Park EK, Seoung JS, et al. Liver resection for hepatocellular carcinoma:case-matched analysis of laparoscopic versus open resection[J]. J Korean Surg Soc, 2011, 80(6):412-419.
- 15. Truant S, Bouras AF, Hebbar M, et al. Laparoscopic resection vs. open liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease:a case-matched study[J]. Surg Endosc, 2011, 25(11):3668-3677.
- 16. Hu BS, Chen K, Tan HM, et al. Comparison of laparoscopic vs. open liver lobectomy (segmentectomy) for hepatocellular carcinoma[J]. World J Gastroenterol, 2011, 17(42):4725-4728.
- 17. Reich H, McGlynn F, DeCaprio J,et al. Laparoscopic excision of benign liver lesions[J]. 0bstet Gynecol, 1991, 78(5 Pt 2):956-968.
- 18. Wayand W,Woisetschlager R. Laparoscopic resection of liver metastasis[J]. Chirurg, 1993, 64(3):195-197.
- 19. 周偉平, 孫志宏, 吳盂超, 等. 經(jīng)腹腔鏡肝葉切除首例報(bào)道[J]. 肝膽外科雜志, 1994, 2(2):82.
- 20. 李朝龍, 鄒衍泰, 于曉園, 等. 腹腔鏡肝腫瘤切除[J]. 現(xiàn)代臨床普通外科, 1996, 1(1): 29-30.
- 21. 蔡秀軍, 虞洪, 鄭雪詠, 等. 腹腔鏡右半肝切除l例[J]. 中華醫(yī)學(xué)雜志,2005, 85(13): 869.
- 22. 劉榮, 胡明根, 王剛. 完全腹腔鏡肝右三葉切除1例[J]. 中華醫(yī)學(xué)雜志,2005, 85(25): 1783.
- 23. 劉榮, 胡明根. 腹腔鏡肝段葉切除的難點(diǎn)與對(duì)策[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007, 17(5):510-511.
- 24. Kaneko H, Tsuchiya M, Otsuka Y, et al. Laparoscopic hepatectomy for hepatocellular carcinoma in cirrhotic patients[J]. J Hepatobiliary Pancreat Surg, 2009, 16(4):433-438.
- 25. Chen HY, Juan CC, Ker CG. Laparoscopic liver surgery for patients with hepatocellular carcinoma[J]. Ann Surg Oncol, 2008, 15(3): 800-806.
- 26. 劉天錫, 方登華, 關(guān)斌穎, 等. 腹腔鏡肝切除治療肝臟腫瘤的臨床探討[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2012, 19(5):526-529.
- 27. Gigot JF, Glineur D, Santiago Azagra J, et al. Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study[J]. Ann Surg, 2002, 236(1):90-97.