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目的:采用荟萃分析比较腹腔镜与开腹大范围肝切除治疗肝脏肿瘤的近期疗效及安全性。方法:大范围肝切除术是≥3个肝段的肝切除手术。计算机检索至2014年6月的Pub Med、EMbase、Cochrane、CBM、CNKI、万方、维普数据库相关文献,收集并比较两种方式治疗肝脏肿瘤的临床对照研究。采用Rev Man5.2软件对数据行荟萃分析。结果:未获得随机对照试验,纳入7项临床同期对照试验,共863例(腹腔镜组275例,开腹组588例)。荟萃分析结果显示:腹腔镜大范围肝切除术中出血量[加权均数差(weight mean difference,WMD)为-158.38 m L,95%CI:-233.81~-82.96,P<0.000 1]、术后并发症发生率(RR=0.47,95%CI:0.35~0.62,P<0.000 01)、术后住院天数(WMD=-4.26 d,95%CI:-4.80~-3.71,P<0.000 01)均优于开腹大范围肝切除术,而手术时间(WMD=1.05 min,95%CI:-24.53~26.62,P=0.94)及术中输血率(RR=0.45,95%CI:0.18~1.15,P=0.10)方面,两者差异无统计学意义。结论 :外科治疗肝脏肿瘤中,与开腹大范围肝切除术治疗肝脏肿瘤作比较,腹腔镜大范围肝切除术具有术中出血少、术后并发症发生率低、住院时间短等优点,近期疗效佳。
OBJECTIVE: To evaluate the short-term efficacy and safety of meta-analysis comparing laparoscopic and open radical hepatectomy for hepatic tumors. Methods: A wide range of hepatectomy is a hepatectomy for> 3 hepatic segments. PubMed, EMbase, Cochrane, CBM, CNKI, Wanfang and VIP databases were searched by computer to collect and compare the two clinical control studies on liver tumors. Rev Man5.2 software was used for meta-analysis of data. Results: Randomized controlled trials were not included. Seven clinical controlled trials were enrolled. A total of 863 patients were included (laparoscopic group 275, laparotomy 588). Meta-analyzes showed that the amount of bleeding during laparoscopic extensive liver resection (weight mean difference [WMD] -158.38 m L, 95% CI: -233.81 to -82.96, P <0.0001) The incidence of postoperative complication (RR = 0.47, 95% CI: 0.35-0.62, P <0.000 01) and postoperative hospital stay (WMD = -4.26 days, 95% CI: -4.80-3.71, P <0.000 01) (WMD = 1.05 min, 95% CI: -24.53 ~ 26.62, P = 0.94) and intraoperative blood transfusion rate (RR = 0.45, 95% CI: 0.18 ~ 1.15 , P = 0.10), the difference was not statistically significant. Conclusion: Surgical treatment of liver tumors, and laparotomy of liver resection for a wide range of liver resection, laparoscopic wide-band hepatectomy with less bleeding, postoperative complications, shorter hospital stay, etc., the recent Good effect.