Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
HPB (Oxford). 2019 Sep;21(9):1119-1130. doi: 10.1016/j.hpb.2019.02.022. Epub 2019 Mar 27.
The value of open and minimally invasive liver resection for symptomatic solid benign liver tumours (BLT) such as hepatocellular adenoma, focal nodular hyperplasia and haemangioma is being debated. A systematic review on symptom relief, quality of life (QoL) and surgical outcome after both open and minimally invasive surgery for solid BLT is currently lacking.
A systematic search in PubMed and EMBASE was performed according to the PRISMA guidelines (January 1985-April 2018). Articles reporting pre-and postoperative symptoms or QoL in patients undergoing open or minimally surgery for BLT were evaluated. Methodological quality was assessed using the MINORS tool.
Forty-two studies were included with 4061 patients undergoing surgery for BLT, 3536 (87%) open and 525 (13%) laparoscopic resections. Randomized and propensity-matched studies were lacking. Symptoms were the indication for resection in 56% of the patients. After a weighted mean of 28.5 months follow-up after surgery, symptoms were relieved in 82% of symptomatic patients. Validated QoL tools were used in eight studies, of which two found significant better QoL scores following laparoscopic compared to open surgery.
Resection of symptomatic BLT seems safe and relieves symptoms in the vast majority of selected patients. Comparative studies are needed before more firm conclusions can be drawn.
对于有症状的实体良性肝肿瘤（BLT），如肝细胞腺瘤、局灶性结节性增生和肝血管瘤，开放和微创肝切除术的价值仍存在争议。目前缺乏关于开放和微创治疗实体 BLT 后症状缓解、生活质量（QoL）和手术结果的系统评价。
根据 PRISMA 指南（1985 年 1 月至 2018 年 4 月），在 PubMed 和 EMBASE 中进行了系统搜索。评估了报告接受 BLT 开放或微创治疗的患者术前和术后症状或生活质量的文章。使用 MINORS 工具评估方法学质量。
共纳入 42 项研究，共计 4061 例 BLT 患者接受手术治疗，其中 3536 例（87%）为开放性手术，525 例（13%）为腹腔镜手术。缺乏随机和倾向匹配研究。56%的患者因症状而行切除术。手术后平均随访 28.5 个月后，82%有症状的患者症状得到缓解。8 项研究使用了有效的 QoL 工具，其中 2 项研究发现腹腔镜手术的 QoL 评分明显优于开放手术。
切除有症状的 BLT 似乎是安全的，并且可以缓解大多数选定患者的症状。在得出更确切的结论之前，需要进行比较研究。
