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
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.