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目的系统评价腹腔镜肝切除术(laparoscopic hepatectomy,LH)与开腹肝切除术(open hepatectomy,OH)治疗肝癌(hepatocellular carcinoma,HCC)的疗效及安全性。方法计算机检索PubMed、EMbase、MEDLINE、SCI、CNKI、CBM、WanFang Data和The Cochrane Library(2012年第3期),收集LH与OH治疗HCC的随机或非随机同期对照试验,检索时限截止到2012年8月。由两名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用RevMan 5.1软件进行Meta分析。结果纳入13个非随机对照试验,共701例患者。Meta分析结果显示:LH治疗HCC较OH术中出血量少[MD=–144.09,95%C(I–194.25,–93.94),P<0.000 01],住院天数短[MD=–5.48,95%CI(–7.10,–3.85),P<0.000 01],术后并发症少[OR=0.43,95%CI(0.27,0.66),P=0.000 1]。但两组在手术时间[MD=–0.64,95%CI(–22.95,21.68),P=0.96]、围手术期死亡率、3～5年生存率、无瘤生存率等方面差异无统计学意义。结论 LH治疗HCC较OH具有创伤小、术中出血量较少、住院时间短、术后并发症少等特点,并在手术时间、围手术期死亡率、3～5年生存率等方面与OH无明显差异。因此,在严格掌握LH治疗HCC适应证的前提下,采用LH治疗肝癌是安全可行的。由于纳入研究数量和质量存在局限性,上述结论仍需大样本、高质量的RCT进一步验证。临床医生应根据HCC患者的具体情况,综合评估病情,选择最佳的治疗方式。
Objective To evaluate the efficacy and safety of laparoscopic hepatectomy (LH) and open hepatectomy (OH) in the treatment of hepatocellular carcinoma (HCC). Methods PubMed, EMbase, MEDLINE, SCI, CNKI, CBM, WanFang Data and The Cochrane Library were collected by computer (2012 Issue 3). Randomized or nonrandomized controlled trials of LH and OH for the treatment of HCC were performed. The search period was up to 2012 August. Two reviewers selected trials based on inclusion and exclusion criteria, extracted data, and evaluated the quality. Meta-analysis was performed using RevMan 5.1 software. Results A total of 701 non-randomized controlled trials were included. The results of Meta analysis showed that LH treatment had less blood loss than that of OH [MD = -144.09,95% C (I-194.25, -93.94), P <0.000 01], hospitalization days were short [MD = -5.48,95% CI (-7.10, -3.85), P <0.000 01]. There was less postoperative complications [OR = 0.43, 95% CI (0.27, 0.66), P = 0.0001]. However, there was no significant difference between the two groups in the operation time [MD = -0.64, 95% CI (-22.95, 21.68), P = 0.96], perioperative mortality, 3- to 5-year survival, significance. Conclusion Compared with OH, LH has less trauma, less intraoperative blood loss, shorter hospital stay and fewer postoperative complications. Compared with OH, OH has a significant effect on the operation time, perioperative mortality and 3- to 5-year survival rate No significant difference. Therefore, under the premise of strict control of HCC indications for the treatment of HCC, the treatment of liver cancer with LH is safe and feasible. Due to limitations in the number and quality of studies included, the above conclusions still require further validation of large samples and high quality RCTs. Clinicians should be based on the specific circumstances of patients with HCC, comprehensive assessment of the disease, choose the best treatment.