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目的系统评价腹腔镜手术(laparoscopic hepatectomy,LH)与开腹手术(open hepatectomy,OH)比较治疗肝细胞癌的疗效和安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、CBM、WanFang Data和CNKI数据库,搜集有关LH和OH治疗肝细胞癌的病例-对照研究,检索时限均为建库至2015年12月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件对数据进行Meta分析。结果共纳入28个研究,包括1 908例患者。Meta分析结果显示:与OH相比,LH能减少术后并发症[OR=0.35,95%CI(0.26,0.48),P<0.000 01]、缩短住院时间[MD=–4.18,95%CI(–5.08,–3.29),P<0.000 01]、增加5年总生存率[OR=1.65,95%CI(1.23,2.19),P=0.000 7]和5年肿瘤特异性生存率[OR=1.51,95%CI(1.12,2.03),P=0.006]。但两种术式在1年和3年的总生存率、肿瘤特异性生存率及术后复发率方面差异无统计学意义。结论 LH比OH治疗肝细胞癌具有更好疗效和安全性,LH有望成为肝细胞癌患者的首选治疗方案。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。
Objective To evaluate the efficacy and safety of laparoscopic hepatectomy (LH) and open hepatectomy (OH) in the treatment of hepatocellular carcinoma. METHODS: PubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases were searched by computer to collect case-control studies on the treatment of hepatocellular carcinoma with LH and OH. The search period was from December to December 2015. After two researchers independently screened the literature, extracted data, and assessed the risk of being included in the study, RevMan 5.3 software was used to perform meta-analysis of the data. Results A total of 28 studies were included, including 1 908 patients. Meta-analysis showed that LH reduced postoperative complications compared with OH [OR = 0.35, 95% CI (0.26, 0.48), P <0.000 01] and shortened hospital stay [MD = -4.18, 95% CI (OR = 1.65, 95% CI (1.23, 2.19), P = 0.0007] and 5-year tumor-specific survival rate [OR = 1.51 , 95% CI (1.12, 2.03), P = 0.006]. However, there was no significant difference in the overall survival rate, tumor-specific survival rate and postoperative recurrence rate between the two procedures at 1 year and 3 years. Conclusion LH is better than OH in the treatment of hepatocellular carcinoma with better efficacy and safety, LH is expected to be the first choice of treatment for patients with hepatocellular carcinoma. Due to the limited number and quality of studies included, the above conclusions have yet to be validated by more high-quality studies.