临床研究(Clinical Research)

微创肝切除与开腹肝切除治疗肝内结石的Meta分析

Published at: 2017年第26卷第8期

雷焦 1 , 黄隽敏 2 , 杨小波 1 , 章园 1
1 三峡大学人民医院 普通外科,湖北 宜昌 443000
2 荆州市中心医院 手术室,湖北 荆州 434000
通讯作者 园 章 Email: zhangyuan1975@139.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.08.009
基金:

摘要

目的:评价微创肝切除治疗肝内结石的安全性和有效性。方法:计算机检索国内外数据库,收集比较微创肝切除与开腹肝切除治疗肝内结石的文献,提取有效数据后用Stata 12.0软件进行Meta分析。结果:最终纳入24篇相关文献,共有2 051例患者,其中993例行微创肝切除,1 058例行开腹肝切除。Meta分析结果显示,与开腹肝切除比较,微创肝切除术中出血量减少(SMD=-0.867,95% CI=-1.261~-0.472,P<0.001)、输血率降低(OR=0.475,95% CI=0.330~0.683,P<0.001)、术后并发症发生率降低(OR=0.493,95% CI=0.382~0.638,P<0.001)、术后禁食时间缩短(SMD=-1.845,95% CI=-2.609~-1.082,P<0.001)、术后住院时间减少(SMD=-0.983,95% CI=-1.323~-0.643,P<0.001)、结石复发率降低(OR=0.513,95% CI=0.322~0.816,P=0.005),而两种手术方式的手术时间、术中结石清除率、最终结石清除率均无统计学差异(均P>0.05)。结论:微创肝切除治疗肝内胆管结石是一种安全有效的手术方式,且多数术中、术后指标优于开腹手术,但仍需要更多临床随机对照试验进一步证实。


Minimally invasive hepatectomy versus open hepatectomy for hepatolithiasis: a Meta-analysis

Abstract

Objective: To evaluate the safety and efficacy of minimally invasive hepatectomy for hepatolithiasis. Methods: Literature regarding studies comparing minimally invasive hepatectomy and open hepatectomy for hepatolithiasis was collected through searching several national and international online databases. After data extraction, Meta-analysis was performed by using Stata 12.0 software. Results: Twenty-four studies were finally included involving 2 051 patients, of whom, 993 cases underwent minimally invasive hepatectomy and 1 058 cases underwent open hepatectomy. Results of Meta-analysis showed that minimally invasive hepatectomy had significantly reduced intraoperative blood loss (SMD=–0.867, 95% CI=–1.261––0.472, P<0.001), blood transfusion rate (OR=0.475, 95% CI=0.330–0.683, P<0.001), incidence of postoperative complications (OR=0.493, 95% CI=0.382–0.638, P<0.001), postoperative fasting time (SMD=–1.845, 95% CI=–2.609––1.082, P<0.001), length of postoperative hospital stay (SMD=–0.983, 95% CI=–1.323––0.643, P<0.001) and stone recurrence rate (OR=0.513, 95% CI=0.322–0.816, P=0.005) compared with open hepatectomy, while no significant differences were noted in operative time, initial stone clearance rate and final stone clearance rate between the two approaches (all P>0.05). Conclusion: Minimally invasive hepatectomy is a safe and effective approach for hepatolithiasis, and is superior to open hepatectomy in most intra- and postoperative variables. However, more randomized controlled trials are still needed to verify these differences.


comments powered by Disqus

全文

引用

引用本文: 焦 雷, 隽敏 黄, 小波 杨, 园 章. 微创肝切除与开腹肝切除治疗肝内结石的Meta分析 [J]. 中国普通外科杂志, 2017, 26(8): 1007-1018.
Cite this article as: LEI Jiao, HUANG Junmin, YANG XiaoBo, ZHANG Yuan . Minimally invasive hepatectomy versus open hepatectomy for hepatolithiasis: a Meta-analysis [J]. Chin J Gen Surg, 2017, 26(8): 1007-1018.