Zheng Xin, Dou Changwei, Yao Yingmin, Liu Qingguang
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University , Xi'an, Shaanxi, China .
J Laparoendosc Adv Surg Tech A. 2015 Feb;25(2):103-11. doi: 10.1089/lap.2014.0506.
The aim of this meta-analysis was to determine whether laparoscopic splenectomy (LS) and LS with esophagogastric devascularization (LSED) were the minimally invasive alternative for portal hypertension.
A meta-analysis of comparative clinical trials was performed to assess our questions noted above. The databases PubMed, ScienceDirect, and Springerlink were searched.
In total, 725 patients with liver cirrhosis and/or portal hypertension from eight published comparative trials were included. The operation time in the laparoscopic group was more than that in the open group [weighted mean difference (WMD) 35.24 (16.74, 53.74); P<.001]. However, there were less intraoperative blood loss [WMD -194.84 (-321.34, -68.34); P=.003] and a shorter postoperative hospital stay [WMD -4.33 (-5.30, -3.36); P<.001] in the laparoscopic group. The incidence of complications was similar in the two groups. In the subgroup studies about LS versus open splenectomy, no significant differences were found in operation time, intraoperative blood loss, and complication rates. The postoperative hospital stay in the LS group was apparently decreased [WMD -4.07 (-4.93, -3.21); P<.001]. Although the operation time of LSED was longer [WMD 43.23 (17.13, 69.32); P=.001], LSED was associated with less intraoperative blood loss [WMD -189.26 (-295.71, -82.81); P<.001] and a shorter postoperative hospital stay [WMD -5.41 (-7.84, -2.98); P<.001]. Meta-analysis did not favor either LSED or open splenectomy with esophagogastric devascularization in term of complication rates.
The results of this meta-analysis were in favor of LS and LSED for being a safe, minimally invasion alternative for patients with liver cirrhosis and portal hypertension.
本荟萃分析的目的是确定腹腔镜脾切除术（LS）以及联合食管胃去血管化的腹腔镜脾切除术（LSED）是否为门静脉高压症的微创替代治疗方法。
进行了一项比较临床试验的荟萃分析，以评估上述问题。检索了PubMed、ScienceDirect和Springerlink数据库。
总共纳入了来自八项已发表的比较试验中的725例肝硬化和/或门静脉高压症患者。腹腔镜组的手术时间比开放手术组长[加权均数差（WMD）35.24（16.74，53.74）；P<0.001]。然而，腹腔镜组术中失血量较少[WMD -194.84（-321.34，-68.34）；P = 0.003]，术后住院时间较短[WMD -4.33（-5.30，-3.36）；P<0.001]。两组并发症发生率相似。在关于LS与开放脾切除术的亚组研究中，手术时间、术中失血量和并发症发生率方面未发现显著差异。LS组术后住院时间明显缩短[WMD -4.07（-4.93，-3.21）；P<0.001]。尽管LSED的手术时间较长[WMD 43.23（17.13，69.32）；P = 0.001]，但LSED术中失血量较少[WMD -189.26（-295.71，-82.81）；P<0.001]，术后住院时间较短[WMD -5.41（-7.84，-2.98）；P<0.001]。荟萃分析在并发症发生率方面未显示LSED或开放食管胃去血管化脾切除术具有优势。
本荟萃分析结果支持LS和LSED作为肝硬化和门静脉高压症患者安全、微创的替代治疗方法。
