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腹腔镜肝切除术治疗肥胖患者肝肿瘤的益处:一项荟萃分析。

Benefits of laparoscopic liver resection for liver tumors in obese patients: a meta-analysis.

作者信息

Zhang Jie, Zeng Cuifang, Chen Rui, Tang Gang, Zhou Rongxing

机构信息

Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

出版信息

Front Oncol. 2024 Oct 22;14:1489261. doi: 10.3389/fonc.2024.1489261. eCollection 2024.

DOI:10.3389/fonc.2024.1489261
PMID:39502316
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11534604/
Abstract

OBJECTIVE

The superiority of laparoscopic liver resection (LLR) and open liver resection (OLR) in obese patients remains controversial. The study aims to assess the available literature and compare the perioperative outcomes of LLR and OLR for liver tumors in obese patients.

METHODS

We searched PubMed, Cochrane Library, Embase, and Web of Science databases for studies comparing LLR and OLR. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated.

RESULTS

Nine studies were included, with a total of 1116 patients (LLR group: 482 patients; OLR group: 634 patients). Compared with OLR, LLR has lower overall morbidity (OR 0.47, 95% CI 0.34, 0.64), major complications (OR 0.45, 95% CI 0.25, 0.82), surgical site infection (OR 0.18, 95% CI 0.07, 0.48), bile leak (OR 0.45, 95% CI 0.22, 0.95), less blood loss (MD, -329.12 mL; 95% CI, -623.35, -34.88), and shorter length of stay (MD, -5.20 days; 95% CI, -7.43, -2.97). There were no significant differences in mortality, operation time, liver failure, and blood transfusion between the two groups.

CONCLUSIONS

LLR for obese patients is safe and feasible. Compared to OLR, it offers better short-term outcomes. Further randomized controlled trials to verify the potential advantages of LLR over OLR are warranted.

摘要

目的

腹腔镜肝切除术(LLR)和开腹肝切除术(OLR)在肥胖患者中的优势仍存在争议。本研究旨在评估现有文献,并比较LLR和OLR治疗肥胖患者肝肿瘤的围手术期结果。

方法

我们检索了PubMed、Cochrane图书馆、Embase和Web of Science数据库,以查找比较LLR和OLR的研究。计算了比值比(OR)和平均差(MD)以及95%置信区间(CI)。

结果

纳入9项研究,共1116例患者(LLR组:482例患者;OLR组:634例患者)。与OLR相比,LLR的总体发病率较低(OR 0.47,95%CI 0.34,0.64)、主要并发症较少(OR 0.45,95%CI 0.25,0.82)、手术部位感染较少(OR 0.18,95%CI 0.07,0.48)、胆漏较少(OR 0.45,95%CI 0.22,0.95)、失血量较少(MD,-329.12 mL;95%CI,-623.35,-34.88),住院时间较短(MD,-5.20天;95%CI,-7.43,-2.97)。两组在死亡率、手术时间、肝衰竭和输血方面无显著差异。

结论

肥胖患者行LLR是安全可行的。与OLR相比,它具有更好的短期结果。有必要进行进一步的随机对照试验,以验证LLR相对于OLR的潜在优势。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/67ec/11534604/444816818070/fonc-14-1489261-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/67ec/11534604/8507a168db84/fonc-14-1489261-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/67ec/11534604/ea34e6f5c981/fonc-14-1489261-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/67ec/11534604/59cfee543a4d/fonc-14-1489261-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/67ec/11534604/444816818070/fonc-14-1489261-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/67ec/11534604/8507a168db84/fonc-14-1489261-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/67ec/11534604/ea34e6f5c981/fonc-14-1489261-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/67ec/11534604/59cfee543a4d/fonc-14-1489261-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/67ec/11534604/444816818070/fonc-14-1489261-g004.jpg

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Surg Endosc. 2024 Aug;38(8):4583-4593. doi: 10.1007/s00464-024-11002-7. Epub 2024 Jul 1.
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Positive impact of laparoscopic hepatectomy versus open hepatectomy on body size-corrected bleeding in obese patients.腹腔镜肝切除术与开腹肝切除术对肥胖患者体型校正出血的影响。
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A systematic review and meta-analysis of short-term outcomes comparing the efficacy of robotic versus laparoscopic colorectal surgery in obese patients.
一项系统评价和荟萃分析比较了肥胖患者机器人与腹腔镜结直肠手术短期疗效的比较。
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Indications, trends, and perioperative outcomes of minimally invasive and open liver surgery in non-obese and obese patients: An international multicentre propensity score matched retrospective cohort study of 9963 patients.非肥胖和肥胖患者微创与开腹肝手术的适应证、趋势和围手术期结局:一项国际多中心倾向评分匹配回顾性队列研究纳入 9963 例患者。
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