Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China.
The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
PLoS One. 2020 Mar 11;15(3):e0229870. doi: 10.1371/journal.pone.0229870. eCollection 2020.
To evaluate the effect of intermittent pringle maneuver (IPM) on the long-term prognosis and recurrence of hepatocellular carcinoma (HCC).
Eligible studies were identified by PubMed and other databases from Jan 1st 1990 to Mar 31st 2019. Hazard ratios (HR) with 95% confidence interval (CI) were calculated to evaluate the effects of IPM on the long-term prognosis and recurrence of patients with HCC.
Six studies were enrolled in this meta-analysis. Results showed that there were no differences between IPM group and non-IPM group in the pooled HRs for the overall survival (OS) and disease-free survival (DFS) (HR 1.04, 95%CI 0.841.28, P = 0.74; HR 0.93, 95%CI 0.811.07, P = 0.29; respectively). However, subgroup analysis showed that the pooled Odd ratios (OR) for the 1-year OS and DFS rates of the IPM group when compared with the non-IPM group were 0.65 (95% CI 0.450.94, P = 0.02), 0.38 (95% CI 0.200.72, P = 0.003), respectively. In addition, there were no significant differences in the proportions of liver cirrhosis, HBsAg (+), Child-Pugh A class, multiple tumor, vascular invasion, and major hepatectomy between groups of IPM and non-IPM.
Since IPM would increase the risk of early-recurrence, it should be used cautiously in the procedure of hepatectomy for resectable HCC. However, the current conclusion needs further validation.
CRD 42019124923.
评估间歇阻断入肝血流（IPM）对肝细胞癌（HCC）长期预后和复发的影响。
通过 PubMed 和其他数据库，自 1990 年 1 月 1 日至 2019 年 3 月 31 日，检索相关文献，评估 IPM 对 HCC 患者长期预后和复发的影响。
本荟萃分析纳入 6 项研究。结果显示，IPM 组和非 IPM 组的总生存（OS）和无病生存（DFS）的汇总 HR 无显著差异（HR 1.04，95%CI 0.841.28，P = 0.74；HR 0.93，95%CI 0.811.07，P = 0.29）。然而，亚组分析显示，与非 IPM 组相比，IPM 组 1 年 OS 和 DFS 率的汇总 OR 分别为 0.65（95%CI 0.450.94，P = 0.02）和 0.38（95%CI 0.200.72，P = 0.003）。此外，两组间肝硬化、HBsAg（+）、Child-Pugh A 级、多发肿瘤、血管侵犯和大肝切除的比例无显著差异。
虽然 IPM 会增加早期复发的风险，但在可切除 HCC 的肝切除术中应谨慎使用。然而，目前的结论还需要进一步验证。
CRD 42019124923。
