Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Zhejiang, China.
Department of Hepatopancreatobiliary Surgery, Taizhou Enze Medical Center (Group), Enze Hospital, Zhejiang, China.
World J Surg Oncol. 2023 Nov 21;21(1):359. doi: 10.1186/s12957-023-03244-x.
Intermittent Pringle maneuver (IPM) is commonly used to control bleeding during liver resection. IPM can cause ischemia-reperfusion injury, which may affect the prognosis of patients with hepatocellular carcinoma (HCC). The present meta-analysis was conducted to evaluate the effect of IPM use on perioperative outcomes and long-term survival in patients with HCC.
A systemic literature search was performed in the PubMed, Embase, Web of Science, and Cochrane Library databases to identify randomized controlled trials and retrospective studies that compared the effect of IPM with no Pringle maneuver during liver resection in patients with HCC. Hazard ratio (HR), risk ratio, standardized mean difference, and their 95% confidence interval (CI) values were calculated based on the type of variables.
This meta-analysis included nine studies comprising one RCT and eight retrospective studies and involved a total of 3268 patients. Perioperative outcomes, including operation time, complications, and length of hospital stay, except for blood loss, were comparable between the two groups. After removing the studies that led to heterogeneity, the results showed that IPM was effective in reducing blood loss. Five studies reported overall survival (OS) and disease-free survival (DFS) data and eight studies reported perioperative outcomes. No significant difference in OS and DFS was observed between the two groups (OS: HR, 1.01; 95% CI, 0.85-1.20; p = 0.95; DFS: HR, 1.01; 95% CI, 0.88-1.17; p = 0.86).
IPM is a useful technique to control blood loss during liver resection and does not affect the long-term survival of patients with HCC.
间歇性肝门阻断（IPM）被广泛应用于肝切除术以控制出血。然而，IPM 可能导致缺血再灌注损伤，从而影响肝细胞癌（HCC）患者的预后。本荟萃分析旨在评估 IPM 在 HCC 患者肝切除术中对围手术期结局和长期生存的影响。
系统检索 PubMed、Embase、Web of Science 和 Cochrane 图书馆数据库，以确定比较 HCC 患者肝切除术中使用 IPM 与不使用 Pringle 手法的随机对照试验和回顾性研究。根据变量类型计算危险比（HR）、风险比、标准化均数差及其 95%置信区间（CI）值。
本荟萃分析共纳入 9 项研究，包括 1 项 RCT 和 8 项回顾性研究，共涉及 3268 例患者。除出血量外，两组患者的围手术期结局（包括手术时间、并发症和住院时间）相似。在排除导致异质性的研究后，结果表明 IPM 可有效减少出血量。5 项研究报告了总生存率（OS）和无病生存率（DFS）数据，8 项研究报告了围手术期结局。两组间 OS 和 DFS 无显著差异（OS：HR，1.01；95%CI，0.85-1.20；p=0.95；DFS：HR，1.01；95%CI，0.88-1.17；p=0.86）。
IPM 是控制肝切除术中出血的有效技术，不会影响 HCC 患者的长期生存。
