摘要
目的通过Meta分析的方法比较半肝与全肝入肝血流阻断法在腹腔镜肝切除的效果。方法通过计算机检索中国知网、万方、维普、PubMed数据库,查找比较半肝入肝血流阻断与全肝入肝血流阻断在腹腔镜肝切除术中效果的病例对照研究,检索时限均为2015年1月1日至2019年12月30日。根据纳入及排除标准,由2名研究者独立进行文献筛选、提取资料和质量评估后,采用RevMan5.3软件进行Meta分析。结果10篇相关文献被纳入,共699名患者。与全肝入肝血流阻断法相比,半肝入肝血流阻断法术后并发症较少[OR=0.64,95%CI(0.43,0.95),P=0.03]、在降低术后第1天谷丙转氨酶(Alanine aminotransferase,ALT)[MD=-84.03,95%CI(-99.30,-68.76),P<0.000001]和谷草转氨酶(Aspartate aminotransferase,AST)[MD=-64.97,95%CI(-76.04,-53.90),P<0.00001]、术后第3天ALT[MD=-94.45,95%CI(-152.38,-36.52),P=0.001]和AST[MD=-82.66,95%CI(-135.00,-30.33),P=0.002]及术后第7天ALT[MD=-22.65,95%CI(-38.15,-7.16),P=0.004]和AST[MD=-13.72,95%CI(-18.22,-9.23),P<0.00001]水平有明显优势。但两种阻断方法在手术时间[MD=-5.60,95%CI(-30.56,19.37),P=0.66]、平均阻断时间[MD=0.64,95%CI(-1.93,3.22),P=0.62]、术中出血量[MD=7.61,95%CI(-9.23,24.45),P=0.38]、术中输血量[MD=15.49,95%CI(-24.45,55.43),P=0.45]和术后住院时间[MD=0.83,95%CI(-2.05,0.39),P=0.18]方面无明显差异。结论在腹腔镜肝切除术中应用半肝入肝血流阻断法较全肝入肝血流阻断法能减轻肝功能损害,术后并发症发生率较低。受纳入文献数量和质量的限制,上述结论尚需以后更多高质量研究予以验证。
Objective To assess the effectiveness of half hepatic inflow occlusion and total hepatic inflow occlusion which were applied in the laparoscopic hepatectomy.Methods PubMed,CNKI,WanFang Data and Vip database were searched online to collect case-control study of half hepatic inflow occlusion versus total hepatic inflow occlusion in laparoscopic hepatectomy.Search time limit is January 1,2015 to December 30,2019.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies,and then RevMan 5.2 software was used for data analysis.Results A total of 10 literatures involving 699 patients were included.The results of meta-analysis showed that:compared with the total hepatic inflow occlusion,half hepatic inflow occlusion has less occurrence of complications[OR=0.64,95%CI(0.43,0.95),P=0.03],and has a clear advantage in reducing reduce the 1 postoperative day ALT[MD=-84.03,95%CI(-99.30,-68.76)]and AST[MD=-64.97,95%CI(-76.04,-53.90),P<0.00001],the 3 postoperative day ALT[MD=-94.45,95%CI(-152.38,-36.52),P=0.001]and AST[MD=-82.66,95%CI(-135.00,-30.33),P=0.002]and the 7 postoperative day ALT[MD=-22.65,95%CI(-38.15,-7.16),P=0.004]and AST[MD=-13.72,95%CI(-18.22,-9.23),P<0.00001].However,there were no significant differences in operation time[MD=-5.60,95%CI(-30.56,19.37),P=0.66],average blocking time[MD=0.64,95%CI(-1.93,3.22),P=0.62],intraoperative blood loss[MD=7.61,95%CI(-9.23,24.45),P=0.38],intraoperative blood transfusion[MD=15.49,95%CI(-24.45,55.43),P=0.45]and postoperative hospital stay[MD=0.83,95%CI(-2.05,0.39),P=0.18].Conclusion The half hepatic inflow occlusion can be used to reduce liver function damage and postoperative complications are less than the total hepatic inflow occlusion in laparoscopic hepatectomy.Due to limited by the number and quality of included studies,the above conclusions have yet to be verified by more high-quality studies in the future.
作者
李传涛
王兆映
周迟
崔培元
LI Chuan-tao(The First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China)
出处
《牡丹江医学院学报》
2020年第4期15-22,共8页
Journal of Mudanjiang Medical University
基金
国家自然科学基金资助项目(81600452)。
