已知肝硬化患者肝细胞癌切除的腹腔镜与开放手术入路：系统评价和荟萃分析
Laparoscopic vs open approach to resection of hepatocellular carcinoma in patients with known cirrhosis: systematic review and meta-analysis.
作者信息
Twaij Ahmed, Pucher Philip H, Sodergren Mikael H, Gall Tamara, Darzi Ara, Jiao Long R
机构信息
Ahmed Twaij, Philip H Pucher, Mikael H Sodergren, Ara Darzi, Department of Surgery and Cancer, QEQM Building, St Mary's Hospital, Imperial College, London W2 1NY, United Kingdom.
出版信息
World J Gastroenterol. 2014 Jul 7;20(25):8274-81. doi: 10.3748/wjg.v20.i25.8274.
AIM
To review the currently available literature comparing laparoscopic to open resection of hepatocellular carcinoma (HCC) in patients with known liver cirrhosis.
METHODS
A literature search of MEDLINE, EMBASE, and Cochrane databases was conducted. The search terms used included (laparoscopic OR laparoscopy) AND (hepatic or liver) AND (surgery or resection) AND "hepatocellular carcinoma" AND (cirrhosis or cirrhotic). Furthermore, to widen the search, we also used the "related articles" section. Studies reporting a comparison of outcomes and methods of open vs laparoscopic hepatic resection for HCC in patients with liver cirrhosis were included. Meta-analysis of results was performed using a random effects model to compute relative risk (RR) and for dichotomous variables and standard mean differences (SMD) for continuous variables.
RESULTS
A total of 420 patients from 4 cohort studies were included in final analysis. Patients undergoing laparoscopic procedures had statistically less blood loss compared to the open cohort, SMD of -1.01 (95%CI: -1.23-0.79), P < 0.001, with a reduced risk of transfusion, RR = 0.19 (95%CI: 0.09-0.38), P < 0.001. A wider clearance at tumour resection margins was achieved following a laparoscopic approach, SMD of 0.34 (95%CI: 0.08-0.60), P = 0.011. No significant difference was noted between laparoscopic and open resection operative times, SMD of -0.15 (95%CI: 0.35-0.05), P = 0.142. The overall RR of suffering from postoperative morbidity is 0.25 in favour of the open surgery cohort (95%CI: 0.17-0.37), P < 0.001. Patients under-going laparoscopic surgery had significantly shorter length of stays in hospital compared to the open cohort, SMD of -0.53 (95%CI: -0.73 to -0.32), P < 0.001.
CONCLUSION
This review suggests that laparoscopic resection of hepatocellular carcinoma in patients with cirrhosis is safe and may provide improved patient outcomes when compared to the open technique.
目的
回顾目前比较已知肝硬化患者腹腔镜与开腹肝细胞癌（HCC）切除术的文献。
方法
对MEDLINE、EMBASE和Cochrane数据库进行文献检索。使用的检索词包括（腹腔镜或腹腔镜检查）AND（肝或肝脏）AND（手术或切除术）AND“肝细胞癌”AND（肝硬化或肝硬化的）。此外，为了扩大检索范围，我们还使用了“相关文章”部分。纳入报告了肝硬化患者开腹与腹腔镜肝切除治疗HCC的结果和方法比较的研究。使用随机效应模型对结果进行荟萃分析，以计算相对风险（RR）用于二分变量，计算连续变量的标准化均值差（SMD）。
结果
最终分析纳入了4项队列研究中的420例患者。与开腹组相比，接受腹腔镜手术的患者术中失血在统计学上更少，标准化均值差为-1.01（95%置信区间：-1.23至-0.79），P<0.001，输血风险降低，RR=0.19（95%置信区间：0.09至0.38），P<0.001。采用腹腔镜手术方式在肿瘤切除边缘可获得更宽的切缘，标准化均值差为0.34（95%置信区间：0.08至0.60），P=0.011。腹腔镜和开腹切除术的手术时间无显著差异，标准化均值差为-0.15（95%置信区间：-0.35至0.05），P=0.142。术后并发症总体RR为0.25，支持开腹手术组（95%置信区间：0.17至0.37），P<0.001。与开腹组相比，接受腹腔镜手术的患者住院时间显著缩短，标准化均值差为-0.53（95%置信区间：-0.73至-0.32），P<0.001。
结论
本综述表明，肝硬化患者腹腔镜切除肝细胞癌是安全的，与开腹技术相比可能改善患者预后。
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