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腹腔镜与开腹肝部分切除术治疗肝癌的临床疗效及并发症比较:一项Meta分析

Comparison of Clinical Efficacy and Complications Between Laparoscopic Partial and Open Partial Hepatectomy for Liver Carcinoma: A Meta-Analysis.

作者信息

Shang Hai-Tao, Bao Jian-Heng, Zhang Xi-Bo, Wang Hai-Bo, Zhang Hong-Tao, Li Zhong-Lian

机构信息

Department of Hepatopancreatobiliary Surgery, Nan-Kai Hospital, Tianjin, China.

出版信息

J Laparoendosc Adv Surg Tech A. 2019 Feb;29(2):225-232. doi: 10.1089/lap.2018.0346. Epub 2019 Jan 17.

Abstract

OBJECTIVE

To contrast the clinical effects and complications for the treatment of liver carcinoma in laparoscopic partial hepatectomy (LPH) and open partial hepatectomy (OPH).

METHODS

The multiple databases were adopted to search relevant studies, and the articles eventually satisfying the inclusion criteria were included. All the meta-analyses were conducted with the Review Manager 5.3, and to estimate the quality of each article risk of bias table was performed.

RESULTS

In the end, 17 studies including 3897 patients were involved, which eventually satisfied the eligibility criteria. The number of samples in LPH group and OPH group were 1723 and 2174, respectively. The results of heterogeneity test suggested that recurrence rate (odds ratio [OR] = -20.11, 95% confidence interval, CI [-35.93 to -4.29], P = .01; P for heterogeneity <.00001, I = 100%), hospital days (mean difference (MD) = -2.21, 95% CI [-2.53 to -1.88], P < .000001; P for heterogeneity = .41, I = 58%), and blood loss (MD = -68.09, 95% CI [-85.07 to -51.11], P < .00001; P for heterogeneity = .13, I = 37%) were significantly different, whereas operating time (MD = 4.00, 95% CI [-17.50 to 25.49], P = .72; P for heterogeneity <.00001, I = 99%) and complication events (OR = 0.68, 95% CI [0.46 to 1.01], P = .05; P for heterogeneity = .34, I = 11%) between LPH and OPH were insignificantly different.

CONCLUSION

This study demonstrated that clinical efficacy of OPH was better than that of LPH to some extent, but LPH was a quicker recovery and less harmful therapy.

摘要

目的

对比腹腔镜肝部分切除术(LPH)与开腹肝部分切除术(OPH)治疗肝癌的临床疗效及并发症。

方法

采用多个数据库检索相关研究,纳入最终符合纳入标准的文章。所有荟萃分析均使用Review Manager 5.3进行,并通过偏倚风险表评估每篇文章的质量。

结果

最终纳入17项研究,共3897例患者,均符合纳入标准。LPH组和OPH组的样本量分别为1723例和2174例。异质性检验结果显示,复发率(比值比[OR]= -20.11,95%置信区间,CI[-35.93至-4.29],P = 0.01;异质性P<0.00001,I = 100%)、住院天数(平均差[MD]= -2.21,95%CI[-2.53至-1.88],P<0.000001;异质性P = 0.41,I = 58%)和失血量(MD = -68.09,95%CI[-85.07至-51.11],P<0.00001;异质性P = 0.13,I = 37%)差异有统计学意义,而LPH与OPH之间的手术时间(MD = 4.00,95%CI[-17.50至25.49],P = 0.72;异质性P<0.00001,I = 99%)和并发症事件(OR = 0.68,95%CI[0.46至1.01],P = 0.05;异质性P = 0.34,I = 11%)差异无统计学意义。

结论

本研究表明,OPH的临床疗效在一定程度上优于LPH,但LPH恢复更快,创伤更小。

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