腹腔镜与开腹肝切除术治疗肝内胆管结石有效性及安全性的Meta分析

目的:采用循证医学Meta分析评价腹腔镜肝切除术(laparoscopic hepatectomy,LH)与开腹肝切除术(open hepatectomy,OH)治疗肝内胆管结石的有效性及安全性。方法:计算机检索Pub Med、Embase、OVID、Cochrane library数据库。提取有效数据后采用Review Manager 5.3软件分析。评价指标包括手术指标(手术时间、术中失血及输血、术中结石清除率)及术后指标(术后住院时间、术后并发症、最终结石清除及结石复发率)。结果:共纳入9篇文献,涉及969例患者,其中453例行LH(LH组)、516例行OH(OH组)。结果显示,与OH组相比,LH组术中出血量减少(WMD:-26.18 ml,P=0.02),患者输血需求低(OR:0.38,P=0.005),术后并发症风险低(OR:0.57,P=0.0007),术后住院时间短(WMD:-3.29 d,P=0.0001)。但LH组手术时间长于OH组(WMD:23.70 min,P=0.04)。术中结石清除率(OR:1.22,P=0.43)、最终结石清除率(OR:2.09,P=0.21)、结石复发率(OR:0.63,P=0.21)两组差异无统计学意义。结论:LH治疗肝内胆管结石是安全、有效的,能减少术中出血、输血及术后并发症,缩短住院时间,加速术后康复。

Efficacy and safety comparison of laparoscopic and open hepatectomy for hepatolithiasis:a meta-analysis

Objective:To evaluate the efficacy and safety of laparoscopic hepatectomy ( LH) comparing with open hepatectomy ( OH) for hepatolithiasis. Methods:Literature retrieval was performed by searching PubMed,Embase,OVID and Cochrane library data-bases. After the effective data were extracted,meta analysis was carried out using RevMan 5. 3. The evaluated endpoints included opera-tive outcomes ( operating time,intraoperative blood loss and transfusion,initial stone clearance rate) and postoperative outcomes ( post-operative hospital stay,postoperative complications,final stone clearance rate,stone recurrence rate) . Results:Nine studies totaling 969 patients were included in the meta analysis,with 453 patients in the LH group and 516 patients in the OH group. LH was associated with significantly less intraoperative blood loss (WMD:-26. 18 ml,P=0. 02),lower intraoperative blood transfusion rate (OR:0. 38,P=0.005),fewer incidence of postoperative complications (OR:0. 57,P=0. 0007),and shorter postoperative hospital stay (WMD:-3. 29 d,P=0. 0001). But the operating time was longer compared with the OH group (WMD:23. 70 min,P=0. 04). No significant differences were found in the initial stone clearance rate (OR:1. 22,P=0. 43),final stone clearance rate (OR:2. 09,P=0. 21),stone recurrence rate (OR:0. 63,P=0. 21). Conclusions:LH is safe and effective for hepatolithiasis,and can reduce intraoperative blood loss,blood transfusion,postoperative complications and postoperative hospital stay,and accelerate postoperative recovery.