Wang Feiran, Sun Dongwei, Zhang Nannan, Chen Zhong
Department of General Surgery, Affiliated Hospital of Nantong University, Nantong 226000, China.
Gland Surg. 2020 Apr;9(2):311-320. doi: 10.21037/gs.2020.03.07.
Application of controlled low central venous pressure (LCVP) in liver resection growing in popularity, but its efficacy and safety are still controversial. Our objectives were to assess and compare the efficacy, feasibility, and safety of controlled LCVP in patients undergoing liver resection.
The PubMed, Cochrane library, and EMBASE databases were systematically searched for all the relevant studies regardless of study design. We evaluated the methodological quality of the included studies and excluded studies of poor quality. Moreover, we applied a systematic review and meta-analysis by using RevMan 5.3 software to compare the efficacy and safety of LCVP standard CVP for liver resection. Outcomes included operation time, blood loss, blood infusion, fluid infusion, urinary volume, postoperative complication rates, and hospital stay.
In total, 10 studies, involving 324 patients undergoing liver resection with controlled LCVP, were identified. Meta-analysis displayed that blood loss in the LCVP group was dramatically less than that in the control group (standard CVP group, mean difference (MD): -581.68; 95% CI: -886.32 to -277.05; P=0.0002). Moreover, blood transfusion in the LCVP group was also markedly less than that in the control group (MD: -179.16; 95% CI: -282.00 to -76.33; P=0.0006). However, there was no difference between LCVP group and control group in operation time (MD: -16.24; 95% CI: -39.56 to 7.09; P=0.17), fluid infusion (MD: -287.89; 95% CI: -1,054.47 to 478.69; P=0.46), urinary volume (MD: -26.88; 95% CI: -87.14 to 33.37; P=0.38), ALT (MD: -58.66; 95% CI: -153.81 to 36.50; P=0.23), TBIL (MD: -0.32; 95% CI: -3.93 to 3.28; P=0.86), BUN (MD: -0.13; 95% CI: -0.73 to 0.47; P=0.67), CR (MD: 1.87; 95% CI: -4.90 to 8.63; P=0.59), postoperative complication rates (MD: 0.62; 95% CI: 0.44 to 0.90; P=0.01) and hospital stay (MD: -0.61; 95% CI: -1.68 to 0.46; P=0.26).
Compared with the control, controlled LCVP showed comparable efficacy and safety for the treatment during liver resection.
控制性低中心静脉压（LCVP）在肝切除术中的应用日益普及，但其疗效和安全性仍存在争议。我们的目的是评估和比较控制性LCVP在肝切除患者中的疗效、可行性和安全性。
系统检索PubMed、Cochrane图书馆和EMBASE数据库中所有相关研究，不限研究设计。我们评估纳入研究的方法学质量，排除质量较差的研究。此外，我们使用RevMan 5.3软件进行系统评价和荟萃分析，以比较LCVP与标准中心静脉压（CVP）用于肝切除的疗效和安全性。结局指标包括手术时间、失血量、输血量、液体输入量、尿量、术后并发症发生率和住院时间。
共纳入10项研究，涉及324例接受控制性LCVP肝切除术的患者。荟萃分析显示，LCVP组的失血量显著少于对照组（标准CVP组，平均差值（MD）：-581.68；95%可信区间（CI）：-886.32至-277.05；P = 0.0002）。此外，LCVP组的输血量也显著少于对照组（MD：-179.16；95%CI：-282.00至-76.33；P = 0.0006）。然而，LCVP组与对照组在手术时间（MD：-16.24；95%CI：-39.56至7.09；P = 0.17）、液体输入量（MD：-287.89；95%CI：-1054.47至478.69；P = 0.46）、尿量（MD：-26.88；95%CI：-87.14至33.37；P = 0.38）、谷丙转氨酶（ALT，MD：-58.66；95%CI：-153.81至36.50；P = 0.23）、总胆红素（TBIL，MD：-0.32；95%CI：-3.93至3.28；P = 0.86）、血尿素氮（BUN，MD：-0.13；95%CI：-0.73至0.47；P = 0.67）、肌酐（CR，MD：1.87；95%CI：-4.90至8.63；P = 0.59）、术后并发症发生率（MD：0.62；95%CI：0.44至0.90；P = 0.01）和住院时间（MD：-0.61；95%CI：-1.68至0.46；P = 0.26）方面无差异。
与对照组相比，控制性LCVP在肝切除术中的治疗效果和安全性相当。
