Department of Surgery, Imperial Healthcare NHS Trust, London, UK.
HPB (Oxford). 2011 May;13(5):295-308. doi: 10.1111/j.1477-2574.2011.00295.x. Epub 2011 Mar 2.
Laparoscopic liver resection (LLR) is now considered a feasible alternative to open liver resection (OLR) in selected patients. Nevertheless studies comparing LLR and OLR are few and concerns remain about long-term oncological equivalence. The present study compares outcomes with LLR vs. OLR using meta-analytical methods.
Electronic literature searches were conducted to identify studies comparing LLR and OLR. Short-term outcomes evaluated included operating time, blood loss, length of hospital stay, peri-operative morbidity and resection margin status. Longer-term outcomes included local and distant recurrence, and overall (OS) and disease-free survival (DFS). Meta-analyses were performed using the Mantel-Haenszel method and Cohen's d method, with results expressed as odds ratio (OR) or standardized mean difference (SMD), respectively, with 95% confidence intervals (CI).
Twenty-six studies met the inclusion criteria with a population of 1678 patients. LLR resulted in longer operating time, but reduced blood loss, portal clamp time, overall and liver-specific complications, ileus and length of stay. No difference was found between LLR and OLR for oncological outcomes.
LLR has short-term advantages and seemingly equivalent long-term outcomes and can be considered a feasible alternative to open surgery in experienced hands.
腹腔镜肝切除术（LLR）在某些特定患者中已被视为可替代开腹肝切除术（OLR）的可行方法。然而，比较 LLR 和 OLR 的研究很少，人们对长期肿瘤学等效性仍存在担忧。本研究使用荟萃分析方法比较了 LLR 与 OLR 的结果。
进行电子文献检索以确定比较 LLR 和 OLR 的研究。评估的短期结果包括手术时间、出血量、住院时间、围手术期发病率和切缘状态。更长期的结果包括局部和远处复发，以及总体生存（OS）和无病生存（DFS）。使用 Mantel-Haenszel 方法和 Cohen's d 方法进行荟萃分析，结果分别表示为比值比（OR）或标准化均数差（SMD），置信区间（CI）为 95%。
符合纳入标准的 26 项研究共纳入 1678 例患者。LLR 手术时间较长，但出血量、总肝门阻断时间、总体和肝脏特异性并发症、肠梗阻和住院时间减少。LLR 和 OLR 在肿瘤学结果方面无差异。
LLR 具有短期优势，且长期结果似乎相当，在经验丰富的医生手中，可被视为开腹手术的可行替代方法。
