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有肝硬化和无肝硬化的患者行腹腔镜肝切除术后的手术结局比较:一项荟萃分析。

Surgical outcomes between patients with and without a cirrhotic liver undergoing laparoscopic liver resection: A meta-analysis.

机构信息

Department of Hepatology, Huizhou Municipal Central Hospital, 41, Elingnan road, 516001 Hui Zhou, China.

Department of Hepatobiliary & Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 518116 Shenzhen, China.

出版信息

Clin Res Hepatol Gastroenterol. 2018 Dec;42(6):553-563. doi: 10.1016/j.clinre.2018.06.008. Epub 2018 Aug 10.

Abstract

BACKGROUND

Laparoscopic surgery in patients with liver cirrhosis (CL) is considered to be challenging. Recent studies have shown that laparoscopic liver resection (LLR) is more beneficial of reduced operative stress and postoperative complications in patients with CL.

AIM

A meta-analysis was done to review the currently available published data comparing LLR for patients with CL versus those non-cirrhosis of the liver (NCL).

METHODS

The electronic databases of PubMed, Wiley, Web of Science, Embase, and the Cochrane Library were searched from date of inception to January 29, 2018. Studies reporting a comparison of outcomes and methods of LLR in CL and NCL groups were included. The studies were evaluated using the modified Newcastle-Ottawa Scale.

RESULTS

A total of 1573 patients from six cohort studies were included in final analysis. The CL group had a slightly shorter operative time compared with the NCL group (weighted mean difference [WMD], 18.78min shorter; 95% confidence interval [CI], -43.54-5.98; P=0.14) and delayed hospital stay (WMD, 1.26 days longer; 95% CI, -0.05-2.56; P=0.06). Blood loss, blood transfusion rate, mortality, and conversion rate did not differ significantly between the groups.

CONCLUSIONS

LLR is safe and feasible in the CL compared with the NCL groups. Our present review indicates that LLR should be considered when selecting surgery for patients with CL.

摘要

背景

在肝硬化(CL)患者中进行腹腔镜手术被认为具有挑战性。最近的研究表明,腹腔镜肝切除术(LLR)在减少手术应激和术后并发症方面对 CL 患者更为有益。

目的

进行荟萃分析以回顾比较 CL 患者与非肝硬化(NCL)患者的 LLR 目前可用的已发表数据。

方法

从创建日期到 2018 年 1 月 29 日,检索了 PubMed、Wiley、Web of Science、Embase 和 Cochrane 图书馆的电子数据库。纳入比较 CL 和 NCL 组 LLR 结果和方法的研究。使用改良的 Newcastle-Ottawa 量表评估研究。

结果

最终分析共纳入了来自六项队列研究的 1573 名患者。CL 组的手术时间略短于 NCL 组(加权均数差 [WMD],短 18.78 分钟;95%置信区间 [CI],-43.54-5.98;P=0.14),住院时间延长(WMD,长 1.26 天;95%CI,-0.05-2.56;P=0.06)。两组间出血量、输血率、死亡率和中转率无显著差异。

结论

与 NCL 组相比,CL 患者行 LLR 安全可行。我们的综述表明,在为 CL 患者选择手术时应考虑 LLR。

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