腹腔镜肝切除术治疗结肠癌肝转移的系统评价

摘要

目的：系统评价腹腔镜肝切除（LH）与传统开腹肝切除（OH）治疗结肠癌肝转移的临床效果。方法计算机检索PubMed、Medline、Embase、Cochrane Library等数据库，截止时间至2014年10月，同时根据以上检索所得文献的参考文献进行扩大检索。对入选研究使用Jadad评分法进行质量评价，采用Cochrane协作网提供的RevMan5．3．4统计软件进行Meta分析。结果共纳入10项符合标准的研究，共计786例患者。LH与OH相比，在手术时间、围手术期病死率、5年整体生存率方面差异均无统计学意义（95％CI分别为－61．98～23．68、0．08～4．05、0．60～1．58，P值均＞0．05）。而两组在术中出血量、术后并发症发生率以及住院时间方面差异均具有统计学意义（95％CI分别为－323．17～－113．00、0．38～0．77、－5．01～－2．04，P值均＜0．05）。结论 LH应用于结肠癌肝转移的安全性及效果与OH一致，并具有一定的自身优势。%Objective To evaluate the clinical effects of laparoscopic hepatectomy (LH)versus open hepatectomy (OH)in treating liver metastasis of colon cancer.Methods Relevant literature published up to October 2014 was retrieved from databases including PubMed, Medline,Embase,and Cochrane Library.Extended search was done with reference to the retrieved articles.The quality of selected studies was assessed by the Jadad scale.Meta-analysis was performed using the Cochrane Review Manager software (Version 5.3.4).Results A total of 10 studies involving 786 patients met the inclusion criteria.Meta-analysis showed no significant differences in duration of opera-tion,perioperative mortality,and 5 -year overall survival rate between patients undergoing LH and OH (95%CI:-61.98-23.68,0.08-4.05,and 0.60-1.58,respectively,P>0.05 for all),but there were significant differences in intraoperative blood loss,incidence of post-operative complications,and length of hospital stay (95% CI:-323.17-(-113.00),0.38-0.77,and -5.01 -(-2.04),respec-tively,P<0.05).Conclusion The results of this meta-analysis suggest that LH has comparable efficacy and safety to OH in treating liv-er metastasis of colon cancer and LH has its own advantage.