Department of Hepatobiliary Pancreatic Surgery, The Second People's Hospital of Neijiang, Sichuan Medical University, Neijiang, Sichuan, China.
Department of Hepatobiliary Pancreatic Surgery, The Second People's Hospital of Neijiang, Sichuan Medical University, Neijiang, Sichuan, China.
J Chin Med Assoc. 2018 May;81(5):429-436. doi: 10.1016/j.jcma.2017.09.007. Epub 2017 Oct 25.
In the present study, we aimed to compare laparoscopic hepatectomy (LH) with open hepatectomy (OH) approach in patients with regional hepatolithiasis (RHL) using meta-analytical techniques.
A systematic review of the literature was performed to identify studies comparing LH and OH in the management of RHL. Operative parameters, postoperative outcomes, and postoperative complications were evaluated. Meta-analysis was performed using Review Manage Version 5.0 software.
Nine studies matched the selection criteria, which included 719 patients (LH = 333 and OH = 386). LH was associated with shorter hospital stay (p < 0.00001), earlier oral intake (p < 0.00001), and fewer complications (p = 0.01). No significant statistical divergences were found between the LH and OH groups in terms of operative time (p = 0.48), blood loss (p = 0.07), intraoperative transfusion rate (p = 0.69), initial stone clearance rate (p = 0.33), and postoperative stone recurrence rate (p = 0.23).
LH for regional hepatolithiasis appears to be a promising treatment modality for patients with intrahepatic stones. However, large numbers of patients and prospective, randomized, controlled studies are required to lead to a more comprehensive comparison of the two procedures.
本研究旨在通过荟萃分析技术比较腹腔镜肝切除术（LH）与开腹肝切除术（OH）在区域性肝内胆管结石（RHL）患者中的应用。
系统检索比较 RHL 患者 LH 与 OH 治疗的文献，评估手术参数、术后结局和术后并发症。使用 Review Manage 版本 5.0 软件进行荟萃分析。
符合选择标准的研究有 9 项，共纳入 719 例患者（LH 组 333 例，OH 组 386 例）。LH 组的住院时间更短（p<0.00001），术后开始进食更早（p<0.00001），并发症更少（p=0.01）。两组的手术时间（p=0.48）、术中出血量（p=0.07）、术中输血率（p=0.69）、初始结石清除率（p=0.33）和术后结石复发率（p=0.23）无显著统计学差异。
LH 治疗 RHL 似乎是一种有前途的治疗方法。然而，需要更多的患者和前瞻性、随机、对照研究来对两种手术方法进行更全面的比较。
