前入路与传统入路肝切除术治疗巨大肝癌临床疗效的Meta分析

Comparison of clinical efficacy of hepatectomy via anterior approach and conventional approach for the treatment of giant liver cancer: a Meta analysis

    摘要
  • 摘要: 目的:系统评价前入路与传统入路肝切除术治疗巨大肝癌的临床疗效。
    方法:以原发性肝癌、转移性肝癌、手术、肝切除术、前入路、绕肝提拉法、传统入路、hepatocellular carcinoma、metastatic liver cancer、HCC、surgery、liver resection、hepatectomy、hepatic resection、anterior approach、conventional approach和liver hanging maneuver等为关键词检索Cochrane library、PubMed、EMBASE、Web of Knowledge、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CMCC)、万方数据库。检索时间为各数据库建库至2013年12月。纳入行前入路肝切除术和传统入路肝切除术治疗巨大肝癌的中文和英文文献，再由2名研究者分别独立提取数据，并进行文献质量评价数据分析；应用Review Manager 5.1.2软件进行Meta分析。计数资料采用优势比(OR)分析统计，计量资料采用均数差(MD)分析统计，采用合并值及95%可信区间(95%CI)表示。
    结果:共纳入符合标准的文献13篇，共1 287例肝癌患者，其中前入路肝切除术603例，传统入路肝切除术684例。3篇文献为随机对照试验，1篇偏倚风险高，2篇偏倚风险低；10篇文献为非随机对照试验，平均质量评价为7分(5～9分)。Meta分析结果显示，近期疗效比较：与传统入路肝切除术比较，前入路肝切除术能减少术中出血量(MD=〖KG-*4〗-349.39，95%CI：-636.90～〖KG-*4〗-61.81，P<0.05)，降低输血率(OR=0.41，95%CI：0.24～0.72，P<0.05)，缩短手术时间(MD=〖KG-*4〗-40.81，95%CI：-57.81～-23.80，P<0.05)；缩短平均住院时间(MD=〖KG-*4〗-4.52，95%CI：-8.36～〖KG-*4〗-0.69，P<0.05)；降低术后病死率和并发症发生率(OR=0.32，0.68，95%CI：0.16～0.62，0.53～0.88，P<0.05)。远期疗效比较：前入路肝切除术能降低患者术后肿瘤复发率，有相对更高的1、3年总体生存率(OR=0.45，2.72，4.47，95%CI：0.29～0.69，1.59～4.66，2.61～7.63，P<0.05)。
    结论:肝癌患者施行前入路肝切除术的围术期安全性与传统入路肝切除术相当，近期和远期疗效优于传统入路肝切除术。

     

    Abstract: Objective:To systematically compare the clinical efficacy of hepatectomy via anterior approach and the conventional approach for the treatment of giant liver cancer.
     Methods:The database including Cochrane library, PubMed, Web of Knowledge, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Medical Current Contents (CMCC), Wanfang database were searched with the key words of 原发性肝癌, 转移性肝癌, 手术, 肝切除术, 前入路, 绕肝提拉法, 传统入路,  hepatocellular carcinoma, metastatic liver cancer, HCC, surgery, liver resection, hepatectomy, hepatic resection, anterior approach, conventional approach and liver hanging maneuver between the database establishment and December 2013. Chinese and English literatures on major hepatectomy via anterior approach and conventional approach for the treatment of giant liver cancer were retrieved, and data were analyzed by 2 independent researchers. Meta analysis was carried out using the software of Review Manager 5.1.2. The count data were analyzed using the odds ratio (OR). The quantitative data were analyzed by the weighted mean difference (WMD), and were presented by 95% confidence interval (95%CI).
     Results:Thirteen literatures with 1 287 giant liver cancer patients were retrieved, including 603 patients receiving hepatectomy via anterior approach and 684 via conventional approach. Three literatures were enrolled 〖HJ*4〗in the randomly controlled studies, one had high risk of bias and the other 2 had low risk of bias. Ten literatures were enrolled in the nonrandomly controlled studies with the mean score of 7 (range, 5-9). The results of Meta analysis showed that hepatectomy via anterior approach could reduce the volume of intraoperative blood loss (MD=-349.39, 95%CI:-636.90--61.81, P<0.05), the blood transmission rate (OR=0.41, 95%CI: 0.24-0.72, P<0.05), the operation time (MD=〖KG-*4〗-40.81, 95%CI:-57.81--23.80, P<0.05),  the mean time of hospital stay (MD=〖KG-*4〗-4.52, 95%CI:-8.36--0.69, P<0.05) and the postoperative mortality and incidence of postoperative complications (OR=0.32, 0.68, 95%CI: 0.16-0.62, 0.53-0.88, P<0.05) when compared with the conventional approach, further more, hepatectomy via the anterior approach could reduce the postoperative recurrence of giant liver cancer and had higher overall 1 and 3year survival rates (OR= 0.45, 2.72, 4.47, 95%CI: 0.29-0.69, 1.59-4.66, 2.61-7.63, P<0.05).
     Conclusion:The safety of hepatectomy via anterior approach is similar to that of the conventional approach, while the short and longterm efficacy are superior to those of the conventional approach.

     

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