Department of General Surgery, The Second Affiliated Hospital of Nanchang University, No.1, Minde Road, Nanchang, 330006, Jiangxi, China.
Langenbecks Arch Surg. 2021 Aug;406(5):1307-1316. doi: 10.1007/s00423-020-02055-y. Epub 2021 Jan 6.
Laparoscopic hepatectomy has been used widely due to its advantages as a minimally invasive surgery. However, multicenter, large-scale, population-based laparoscopic caudate lobe resection (LCLR) versus open caudate lobe resection (OCLR) has rarely been reported. We assessed the feasibility and safety of LCLR compared with OCLR using meta-analysis.
Relevant literature was retrieved using PubMed, Embase, Cochrane, Ovid Medline, Web of Science, CNKI, and WanFang Med databases up to July 30th, 2020. Multiple parameters of feasibility and safety were compared between the treatment groups. Quality of studies was assessed with the Newcastle-Ottawa Scale (NOS). The data were analyzed by Review Manager 5.3. Results are expressed as odds ratio (OD) or mean difference (MD) with 95% confidence interval (95% CI) for fixed- and random-effects models.
Seven studies with 237 patients were included in this meta-analysis. Compared with OCLR, the LCLR group had a lower intraoperative blood loss (MD - 180.84; 95% CI - 225.61 to - 136.07; P < 0.0001), shorter postoperative hospital stays (MD - 4.38; 95% CI - 7.07 to - 1.7; P = 0.001), shorter operative time (MD - 50.24; 95% CI - 78.57 to - 21.92; P = 0.0005), and lower rates in intraoperative blood transfusion (OR 0.12; P = 0.01). However, there were no statistically significant differences between LCLR and OCLR regarding hospital expenses (MD 0.92; P = 0.12), pedicle clamping (OR 1.57; P = 0.32), postoperative complications (OR 0.58; P = 0.15), bile leak (P = 0.88), ascites (P = 0.34), and incisional infection (P = 0.36).
LCLR has multiple advantages over OCLR, especially intraoperative blood loss and hospital stays. LCLR is a very useful technology and feasible choice in patients with caudate lobe lesions.
腹腔镜肝切除术因其微创优势已被广泛应用。然而，多中心、大规模、基于人群的腹腔镜尾状叶切除术（LCLR）与开腹尾状叶切除术（OCLR）相比，很少有报道。我们采用荟萃分析评估 LCLR 与 OCLR 的可行性和安全性。
检索了 PubMed、Embase、Cochrane、Ovid Medline、Web of Science、CNKI 和万方数据库，截至 2020 年 7 月 30 日，纳入比较 LCLR 与 OCLR 的治疗组的多项可行性和安全性参数。采用纽卡斯尔-渥太华量表（NOS）评估研究质量。采用 Review Manager 5.3 分析数据。结果表示为固定效应模型和随机效应模型的比值比（OR）或均数差（MD）及其 95%置信区间（95%CI）。
本荟萃分析纳入了 7 项研究共 237 例患者。与 OCLR 相比，LCLR 组术中出血量较少（MD -180.84；95%CI -225.61 至 -136.07；P <0.0001），术后住院时间较短（MD -4.38；95%CI -7.07 至 -1.7；P =0.001），手术时间较短（MD -50.24；95%CI -78.57 至 -21.92；P =0.0005），术中输血率较低（OR 0.12；P =0.01）。然而，LCLR 与 OCLR 组间在住院费用（MD 0.92；P =0.12）、肝蒂夹闭（OR 1.57；P =0.32）、术后并发症（OR 0.58；P =0.15）、胆漏（P =0.88）、腹水（P =0.34）和切口感染（P =0.36）方面无统计学差异。
LCLR 比 OCLR 具有多项优势，特别是术中出血量和住院时间。LCLR 是一种非常有用的技术，对尾状叶病变患者是可行的选择。
