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目的系统评价腹腔镜与开腹行左半肝切除的近期疗效及安全性。方法计算机检索CENTRAL(2012年第1期)、MEDLINE/PubMed(1978～2012)、EMbase(1966～2012)、CBM(1978～2012)、CNKI(1979～2012)和中华医学会数字化期刊系统(1990～2012),收集比较腹腔镜与开腹行左半肝切除的临床试验,并手检相关会议论文及追溯纳入文献的参考文献。由2位评价者根据纳入标准筛选文献、提取资料并评价质量后,采用RevMan5.0版软件进行Meta分析。结果未获得随机对照试验,最终仅纳入5个临床同期对照试验,共319例患者。Meta分析结果显示:腹腔镜组手术时间长于开腹切除组[WMD=40.89,95%CI(29.39,55.38),P<0.000 01],术中出血量少于开腹切除组[WMD=–107.84,95%CI(–208.96,–6.73),P=0.04],而术后住院天数[WMD=–3.78,95%CI(–9.60,2.04),P=0.20]及术后并发症[WMD=0.69,95%CI(0.37,1.29),P=0.25]方面差异均无统计学意义。结论腹腔镜左半肝切除术作为一种微创技术,与开腹左半肝切除术相比,具有腹壁切口较小、术中出血量较少等优点,利于提高患者的生活质量。受纳入研究的数量和质量所限,尚不能判断偏倚对结论可靠性的影响程度。建议今后开展更多高质量大样本多中心且随访时间足够的相关研究以获取更可靠的证据。
Objective To evaluate the short-term efficacy and safety of laparoscopic and open left hepatectomy. Methods The clinical data of CENTRAL (January 2012), MEDLINE / PubMed (1978 ~ 2012), EMbase (1966 ~ 2012), CBM (1978 ~ 2012), CNKI (1979 ~ 2012) and Chinese Medical Association Digital Periodical System ~ 2012). The clinical trials on laparoscopic and open left hepatectomy were collected and hand-searched for relevant conference papers and references retrospectively incorporated into the literature. According to the inclusion criteria, two reviewers screened the literature, extracted the data and evaluated the quality, then used RevMan5.0 software to do the meta-analysis. Results were not randomized controlled trials, culminating in only five clinical concurrent control trials, a total of 319 patients. The results of Meta analysis showed that laparoscopic group had longer operative time than open laparotomy group [WMD = 40.89, 95% CI (29.39, 55.38), P <0.000 01], and the amount of bleeding during operation was less than that of open excision group [WMD = -107.84 , 95% CI (-208.96, -6.73), P = 0.04], and postoperative hospital stay [WMD = -3.78,95% CI (-9.60,2.04), P = 0.20] and postoperative complications [WMD = 0.69, 95% CI (0.37,1.29), P = 0.25], there was no significant difference. Conclusions Laparoscopic left hemihepatectomy is a minimally invasive technique. Compared with open left hemihepatectomy, laparoscopic left hemihepatectomy has the advantages of smaller abdominal incision and less intraoperative blood loss, which helps to improve the quality of life of patients. Due to the quantity and quality of the included studies, it is not yet possible to determine the extent to which the bias affects the reliability of the conclusion. It is recommended that more high-quality, large-sample, multicentre studies with adequate follow-up be conducted in the future to obtain more reliable evidence.