摘要
目的系统评价腹腔镜肝切除(LLR)与开腹肝切除(OLR)治疗结直肠癌肝转移(CRLM)的临床效果和安全性。方法计算机检索中文(知网、万方、维普)和英文数据库(PubMed、Cochrane library、Embase)关于LLR与OLR治疗CRLM的临床对照研究,检索时间为数据库建立至2019年6月。中文检索词包括:结直肠癌肝转移、腹腔镜肝切除术、开腹肝切除术;英文检索词包括:colorectal cancer,colorectal liver metastases,laparoscopic hepatectomy,laparoscopic liver resection,open hepatectomy,open liver resection。对纳入的研究进行质量评价和数据提取后,采用RevMan5.3软件进行Meta分析。结果纳入23项研究,共计4204例患者,其中LLR组1558例,OLR组2646例。Meta分析结果显示,与OLR组比较,LLR组术中出血量减少[均数差(MD)=-145.48,95%可信区间(95%CI):-190.96^-100.00,P<0.001]、输血率降低[比值比(OR)=0.41,95%CI:0.29~0.60,P<0.001]、术后并发症发生率降低(OR=0.55,95%CI:0.47~0.65,P<0.001)、术后住院时间缩短(MD=-2.69,95%CI:-3.29^-2.10,P<0.001)。两组在手术时间、围手术期病死率、R0切除率、1年和5年总体生存率及无瘤生存率等方面差异均无统计学意义(P值均>0.05)。结论LLR治疗CRLM是安全可行的,且近期疗效优于OLR,但该结论仍需更多临床随机对照试验来予以验证。
Objective To systematically evaluate the efficacy and safety of laparoscopic liver resection(LLR)versus open liver resection(OLR)in the treatment of colorectal cancer liver metastasis(CRLM).Methods Chinese databases(CNKI,Wanfang,and VIP)and English databases(PubMed,Cochrane Library,and Embase)were searched for controlled clinical trials on LLR versus OLR in the treatment of CRLM published up to June 2019.Chinese search words were colorectal cancer liver metastasis,laparoscopic liver resection,and open liver resection,and English search words were colorectal cancer,colorectal liver metastases,laparoscopic hepatectomy,laparoscopic liver resection,open hepatectomy,and open liver resection.Quality assessment and data extraction were performed for the studies included,and RevMan5.3 software was used to perform the meta-analysis.Results A total of 23 studies were included,and there were 4204 patients in total,with 1558 patients in LLR group and 2646 in OLR group.The results of the meta-analysis showed that compared with the OLR group,the LLR group had significantly lower intraoperative blood loss(mean difference[MD]=-145.48,95%confidence interval[CI]:-190.96 to-100.00,P<0.001),lower transfusion rate(odds ratio[OR]=0.41,95%CI:0.29-0.60,P<0.001),lower incidence rate of postoperative complications(OR=0.55,95%CI:0.47-0.65,P<0.001),and shorter length of postoperative hospital stay(MD=-2.69,95%CI:-3.29 to-2.10,P<0.001).There were no significant differences between the two groups in time of operation,perioperative mortality rate,R0 resection rate,1-and 5-year overall survival rates,and disease-free survival rate(all P>0.05).Conclusion LLR is safe and feasible in the treatment of CRLM and has better short-term efficacy than OLR,but more randomized controlled trials are needed for verification.
作者
高本见
罗佳
刘莹
杨小李
苏松
李波
GAO Benjian;LUO Jia;LIU Ying(Department of Hepatobiliary Surgery,The Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2020年第3期573-579,共7页
Journal of Clinical Hepatology
基金
白求恩·医学科学研究基金资助项目(KX068DS)。
作者简介
高本见(1995-),男,主要从事肝胆外科的临床研究;通信作者:李波,电子信箱:liboer2002@126.com。
