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腹腔镜左肝外侧叶切除术有望成为治疗左肝叶病变的标准术式：一项荟萃分析。

Laparoscopic left lateral hepatic sectionectomy was expected to be the standard for the treatment of left hepatic lobe lesions: A meta-analysis.

作者信息

Liu Zhou, Ding Haolong, Xiong Xiaoli, Huang Yong

机构信息

Department of Internal Medicine, Jiangxi Provincial Chest Hospital Department of General Surgery, The Third Hospital of Nanchang Department of Radiology, The Second Affiliated Hospital of Nanchang University Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.

出版信息

Medicine (Baltimore). 2018 Feb;97(7):e9835. doi: 10.1097/MD.0000000000009835.

DOI:10.1097/MD.0000000000009835
PMID:29443745
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5839853/
Abstract

BACKGROUND

Laparoscopic left lateral hepatic sectionectomy (LLLHS) has been widely accepted because of the benefits of minimally invasive surgery. We aimed to assess the benefits and drawbacks of left lateral sectionectomy (of segments II/III) compared with laparoscopic and open approaches.

METHODS

Relevant literature was searched using the PubMed, Embase, Cochrane, and Ovid Medline databases. We calculated odds ratios or mean differences with 95% confidence intervals (CIs) for fixed-effects and random-effects models.

RESULTS

The meta-analysis included 14 trials involving 685 patients. There were no statistically significant differences between LLLHS and open LLHS (OLLHS) regarding analgesia (P = .31), pedicle clamping (P = .70), operative time (P = .54), hospital expenses (P = .64), postoperative alanine aminotransferase levels (P = .57), resection margin (95% CI -3.02-4.28; P = .73), or tumor recurrence (95% CI 0.51-3.05; P = .62). However, the LLLHS group showed significantly better results regarding blood transfusion (95% CI 0.14-0.73; P = .007), blood loss (95% CI -140.95 to -67.23; P <.001), total morbidity (95% CI 0.24-0.56; P <.01), and hospital stay (95% CI -3.84 to -2.31; P <.001) than the OLLHS group.

CONCLUSION

LLLHS has an advantage in the hospital stay, blood loss, and total morbidity. It is an ideal method for LLHS surgery.

摘要

背景

由于微创手术的优势，腹腔镜左外叶肝切除术（LLLHS）已被广泛接受。我们旨在评估左外叶（Ⅱ/Ⅲ段）肝切除术与腹腔镜和开放手术方法相比的利弊。

方法

使用PubMed、Embase、Cochrane和Ovid Medline数据库检索相关文献。我们计算了固定效应和随机效应模型的比值比或平均差以及95%置信区间（CI）。

结果

荟萃分析纳入了14项试验，涉及685例患者。LLLHS与开放左外叶肝切除术（OLLHS）在镇痛（P = 0.31）、肝蒂阻断（P = 0.70）、手术时间（P = 0.54）、住院费用（P = 0.64）、术后丙氨酸转氨酶水平（P = 0.57）、切缘（95%CI -3.02 - 4.28；P = 0.73）或肿瘤复发（95%CI 0.51 - 3.05；P = 0.62）方面无统计学显著差异。然而，LLLHS组在输血（95%CI 0.14 - 0.73；P = 0.007）、失血（95%CI -140.95至-67.23；P < 0.001）、总发病率（95%CI 0.24 - 0.56；P < 0.01）和住院时间（95%CI -3.84至-2.31；P < 0.001）方面的结果明显优于OLLHS组。

结论

LLLHS在住院时间、失血和总发病率方面具有优势。它是左外叶肝切除术的理想方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b609/5839853/b4cbf24819c5/medi-97-e9835-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b609/5839853/c010e633f7c4/medi-97-e9835-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b609/5839853/999fc29c4833/medi-97-e9835-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b609/5839853/54c3ede9dbba/medi-97-e9835-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b609/5839853/ac9ea96236c0/medi-97-e9835-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b609/5839853/b4cbf24819c5/medi-97-e9835-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b609/5839853/c010e633f7c4/medi-97-e9835-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b609/5839853/999fc29c4833/medi-97-e9835-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b609/5839853/54c3ede9dbba/medi-97-e9835-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b609/5839853/ac9ea96236c0/medi-97-e9835-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b609/5839853/b4cbf24819c5/medi-97-e9835-g006.jpg

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