腹腔鏡與開腹肝切除術比較治療肝癌的Meta分析_《中國循證醫學雜志》

作者：

姚剛 , 曹峻 , 谷昊 , 張金輝 , 阿依甫汗阿汗 , 曹新嶺 ,  溫浩

新疆醫科大學第一附屬醫院肝（移植）腔鏡外科（烏魯木齊 830054）;

關鍵詞：

腹腔鏡腹腔鏡肝切除術開腹肝切除術肝癌系統評價 Meta分析

DOI：

10.7507/1672-2531.20130103

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目的　系統評價腹腔鏡肝切除術（laparoscopic hepatectomy，LH）與開腹肝切除術(open hepatectomy，OH)治療肝癌（hepatocellular carcinoma，HCC）的療效及安全性。
方法　計算機檢索PubMed、EMbase、MEDLINE、SCI、CNKI、CBM、WanFang Data和The Cochrane Library（2012年第3期），收集LH與OH治療HCC的隨機或非隨機同期對照試驗，檢索時限截止到2012年8月。由兩名評價者按照納入與排除標準選擇試驗、提取資料和評價質量后，采用RevMan 5.1軟件進行Meta分析。
結果　納入13個非隨機對照試驗，共701例患者。Meta分析結果顯示：LH治療HCC較OH術中出血量少［MD= –144.09，95%CI（–194.25，–93.94），P lt;0.000 01］，住院天數短［MD= –5.48，95%CI（–7.10，–3.85），P lt;0.000 01］，術后并發癥少［OR=0.43，95%CI（0.27，0.66），P=0.000 1］。但兩組在手術時間［MD= –0.64，95%CI（–22.95，21.68），P=0.96］、圍手術期死亡率、3～5年生存率、無瘤生存率等方面差異無統計學意義。
結論　LH治療HCC較OH具有創傷小、術中出血量較少、住院時間短、術后并發癥少等特點，并在手術時間、圍手術期死亡率、3～5年生存率等方面與OH無明顯差異。因此，在嚴格掌握LH治療HCC適應證的前提下，采用LH治療肝癌是安全可行的。由于納入研究數量和質量存在局限性，上述結論仍需大樣本、高質量的RCT進一步驗證。臨床醫生應根據HCC患者的具體情況，綜合評估病情，選擇最佳的治療方式。

引用本文： 姚剛,曹峻,谷昊,張金輝,阿依甫汗阿汗,曹新嶺,溫浩. 腹腔鏡與開腹肝切除術比較治療肝癌的Meta分析. 中國循證醫學雜志, 2013, 13(5): 588-595. doi: 10.7507/1672-2531.20130103 復制

1.	Reich H, McGlynn F, Decaprio J, et al. Laparoscopic excision of benign liver lesions. Obstet Gynecol, 1991, 78(5Pt 2): 956-958.
2.	Wayand W, Woisetsehlager R. Laparoscopic resection of liver inetastasis. Chirurg, 1993, 64(3): 195-197.
3.	周偉平, 孫志宏, 吳孟超, 等. 經腹腔鏡肝葉切除首例報道. 肝膽外科雜志, 1994, 2(2): 82-83.
4.	Nguyen KT, Gamblin TC, Geller DA, et al. World review of laparoscopic liver resection-2, 804 patients. Ann Surg, 2009, 250(123): 831-841.
5.	董家鴻, 黃志強. 精準肝切除-21世紀肝臟外科新理念. 中華外科雜志, 2009, 47(21): 1601-1605.
6.	Wells G, Shea B, O’connell D, et al. The Newcastle-Ottawa Scale NOS for assessing the quality of nonrandomized studies in meta-analyses. Ottawa, Canada: Dept of pidemiology and Community Medicine, University of Ottawa.
7.	Shimada M, Hashizume M, Maehara S, et al. Laparoscopic hepatectomy for hepatocellular carcinoma. Surg Endosc, 2001, 15(3): 541-544.
8.	Laurent A, Cherqui D, Lesurtel M, et al. Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg, 2003, 138(7): 763-769.
9.	Kaneko H, Takagi S, Otsuka Y, et al. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg, 2005, 189(2): 190-194.
10.	Belli G, Fantini C, D’Agostino A, et al. Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short and middle term results. Surg Endosc, 2007, 21(5): 2004-2011.
11.	Aldrighetti L, Guzzetti E, Pulitano C, et al. Case-matched analysis of totally laparoscopic versus open liver resection for HCC:short and middle term results. J Surg Oncol, 2010, 102(1): 82-86.
12.	Lai EC, Tang CN, Ha JP, et al. Laparoscopic liver resection for hepatocellular carcinoma: ten-year experience in a single center. Arch Surg, 2009, 144(2): 143-148.
13.	Tranchart H, Di Giuro G, Lainas P, et al. Laparoscopic resection for hepatocellular carcinoma:a matched-pair comparative study. Surg Endosc, 2010, 24(5): 1170-1176.
14.	Sarpel U, Hefti MM, Wisnievsky JP, et al. Outcome for patients treated with laparoscopic versus open resection of hepatocellular carcinoma:case-matched analysis. Ann Surg Oncol, 2009, 16(6): 1572-1577.
15.	Endo Y, Ohta M, Sasaki A, et al. A comparative study of the long-term outcomes after laparoscopy-assisted and open left lateral hepatectomy for hepatocellular carcinoma. Surg Laparosc Endosc Percutan Tech, 2009, 19(5): 171-174.
16.	Hu BS, Chen K, Tan HM, et al. Comparision of laparoscopic versus open liver lobectomy (segentectomy) for hepatocellular carcinoma.World J Gastroenterol, 2011, 17(42): 4725-4728.
17.	Kim HH, Park EK, Seoung JS, et al. Liver resection for hepatocellular carcinoma:case-matched analysis of laparoscopic versus open resection. J Korean Surg Soc, 2011, 80(6): 412-419.
18.	Lee KF, Chong CN, Wong J, et al. Long-term results of laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma:a case matched analysis. World Surg, 2011, 35(10): 2268-2274.
19.	吳志翀, 沈柏用, 彭承宏, 等. 腹腔鏡與開腹肝切除術治療肝細胞肝癌的對照研究. 中華腔鏡外科雜志, 2010, 3(6): 507-512.
20.	Santambrogio R, Opocher E, Ceretti AP, et al. Impact of intraoperative ultrasonography in laparoscopic liver surgery. Surg Endosc, 2007, 21(8): 181-188.
21.	Belli G, Fantini C, D’Agostino A, et al. Laparoscopic left lateralhepatic lobectomy: a safer and faster technique. Hepatobiliary Pancreat Surg, 2006, 13(2): 149-154.

1. Reich H, McGlynn F, Decaprio J, et al. Laparoscopic excision of benign liver lesions. Obstet Gynecol, 1991, 78(5Pt 2): 956-958.
2. Wayand W, Woisetsehlager R. Laparoscopic resection of liver inetastasis. Chirurg, 1993, 64(3): 195-197.
3. 周偉平, 孫志宏, 吳孟超, 等. 經腹腔鏡肝葉切除首例報道. 肝膽外科雜志, 1994, 2(2): 82-83.
4. Nguyen KT, Gamblin TC, Geller DA, et al. World review of laparoscopic liver resection-2, 804 patients. Ann Surg, 2009, 250(123): 831-841.
5. 董家鴻, 黃志強. 精準肝切除-21世紀肝臟外科新理念. 中華外科雜志, 2009, 47(21): 1601-1605.
6. Wells G, Shea B, O’connell D, et al. The Newcastle-Ottawa Scale NOS for assessing the quality of nonrandomized studies in meta-analyses. Ottawa, Canada: Dept of pidemiology and Community Medicine, University of Ottawa.
7. Shimada M, Hashizume M, Maehara S, et al. Laparoscopic hepatectomy for hepatocellular carcinoma. Surg Endosc, 2001, 15(3): 541-544.
8. Laurent A, Cherqui D, Lesurtel M, et al. Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg, 2003, 138(7): 763-769.
9. Kaneko H, Takagi S, Otsuka Y, et al. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg, 2005, 189(2): 190-194.
10. Belli G, Fantini C, D’Agostino A, et al. Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short and middle term results. Surg Endosc, 2007, 21(5): 2004-2011.
11. Aldrighetti L, Guzzetti E, Pulitano C, et al. Case-matched analysis of totally laparoscopic versus open liver resection for HCC:short and middle term results. J Surg Oncol, 2010, 102(1): 82-86.
12. Lai EC, Tang CN, Ha JP, et al. Laparoscopic liver resection for hepatocellular carcinoma: ten-year experience in a single center. Arch Surg, 2009, 144(2): 143-148.
13. Tranchart H, Di Giuro G, Lainas P, et al. Laparoscopic resection for hepatocellular carcinoma:a matched-pair comparative study. Surg Endosc, 2010, 24(5): 1170-1176.
14. Sarpel U, Hefti MM, Wisnievsky JP, et al. Outcome for patients treated with laparoscopic versus open resection of hepatocellular carcinoma:case-matched analysis. Ann Surg Oncol, 2009, 16(6): 1572-1577.
15. Endo Y, Ohta M, Sasaki A, et al. A comparative study of the long-term outcomes after laparoscopy-assisted and open left lateral hepatectomy for hepatocellular carcinoma. Surg Laparosc Endosc Percutan Tech, 2009, 19(5): 171-174.
16. Hu BS, Chen K, Tan HM, et al. Comparision of laparoscopic versus open liver lobectomy (segentectomy) for hepatocellular carcinoma.World J Gastroenterol, 2011, 17(42): 4725-4728.
17. Kim HH, Park EK, Seoung JS, et al. Liver resection for hepatocellular carcinoma:case-matched analysis of laparoscopic versus open resection. J Korean Surg Soc, 2011, 80(6): 412-419.
18. Lee KF, Chong CN, Wong J, et al. Long-term results of laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma:a case matched analysis. World Surg, 2011, 35(10): 2268-2274.
19. 吳志翀, 沈柏用, 彭承宏, 等. 腹腔鏡與開腹肝切除術治療肝細胞肝癌的對照研究. 中華腔鏡外科雜志, 2010, 3(6): 507-512.
20. Santambrogio R, Opocher E, Ceretti AP, et al. Impact of intraoperative ultrasonography in laparoscopic liver surgery. Surg Endosc, 2007, 21(8): 181-188.
21. Belli G, Fantini C, D’Agostino A, et al. Laparoscopic left lateralhepatic lobectomy: a safer and faster technique. Hepatobiliary Pancreat Surg, 2006, 13(2): 149-154.

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腹腔鏡與開腹肝切除術比較治療肝癌的Meta分析

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