目的 系统评价腹腔镜与开腹手术切除治疗肝癌的近期疗效及安全性.方法 计算机检索MEDLINE(1966～2008.3)、Embase(1966～2008.3)、Coehrane图书馆(2008年第1期)和中国生物医学文献数据库(1979～2008.3),手工检索与肝癌治疗相关的<中华肿瘤杂志>等中文期刊,收集腹腔镜切除与开腹切除比较治疗肝癌的随机对照试验和临床对照试验.文献质量评价采用Deeks JJ评价标准,数据提取和文献质量评价由两名评价员独立进行.采用Cochrane协作网专用软件RevMan 4.2.10对数据进行统计分析.结果 未获得随机对照试验,共纳入7个临床同期对照试验,合计309例患者.Meta分析结果显示:①住院期间病死率:4个试验(n=198)表明,腹腔镜组与开腹切除组比较,两组差异无统计学意义[OR=1.14,95%CI(0.15,8.65),P=0.90];②2个试验(n=91)报道了术中输血率,两组差异无统计学意义[OR=0.20,95%CI(0.03,1.19),P=0.08];③4个试验(n=165)结果显示,腹腔镜组肝癌切除手术时间长于开腹组,其差异有统计意义[SMD=1.05,95%Cl (0.72,1.38),P<0.00001];④4个试验(n=165)结果显示,腹腔镜组术中出血量低于开腹组,其差异有统计学意义[SMD=-1.56,95%Cl(-2.39,-0.73),P=0.000 2];⑤5个试验(n=210)结果显示,腹腔镜组术后住院时间短于开腹组,其差异有统计学意义[WMD=-3.89,95%Cl(-5.54,-2.23),P<0.000 01];⑥5个试验(n=248)结果显示,腹腔镜组术后并发症率低于开腹组,其差异有统计学意义[OR=0.31,95%Cl(0.13,0.72),P=0.006];⑦2个试验(n=97)结果显示,腹腔镜组丙氨酸转氨酶(ALT)低于开腹手术组,其差异有统计学意义[SMD=-1.154,95%Cl(-207,-1.01),P<0.000 01].结论 腹腔镜肝癌切除术作为一种微创技术,与开腹肝癌切除术相比具有腹壁切口较小,术中出血量较少,住院时间短,术后并发症率低等优点,有利于提高病人的生活质量.因本系统评价纳入的病例数较少,且纳入均为非随机对照试验,无法确定偏倚对结论可靠性的影响程度.因此上述结论尚需谨慎对待,有必要开展和设计大样本随机对照研究来进一步验证.
目的 繫統評價腹腔鏡與開腹手術切除治療肝癌的近期療效及安全性.方法 計算機檢索MEDLINE(1966～2008.3)、Embase(1966～2008.3)、Coehrane圖書館(2008年第1期)和中國生物醫學文獻數據庫(1979～2008.3),手工檢索與肝癌治療相關的<中華腫瘤雜誌>等中文期刊,收集腹腔鏡切除與開腹切除比較治療肝癌的隨機對照試驗和臨床對照試驗.文獻質量評價採用Deeks JJ評價標準,數據提取和文獻質量評價由兩名評價員獨立進行.採用Cochrane協作網專用軟件RevMan 4.2.10對數據進行統計分析.結果 未穫得隨機對照試驗,共納入7箇臨床同期對照試驗,閤計309例患者.Meta分析結果顯示:①住院期間病死率:4箇試驗(n=198)錶明,腹腔鏡組與開腹切除組比較,兩組差異無統計學意義[OR=1.14,95%CI(0.15,8.65),P=0.90];②2箇試驗(n=91)報道瞭術中輸血率,兩組差異無統計學意義[OR=0.20,95%CI(0.03,1.19),P=0.08];③4箇試驗(n=165)結果顯示,腹腔鏡組肝癌切除手術時間長于開腹組,其差異有統計意義[SMD=1.05,95%Cl (0.72,1.38),P<0.00001];④4箇試驗(n=165)結果顯示,腹腔鏡組術中齣血量低于開腹組,其差異有統計學意義[SMD=-1.56,95%Cl(-2.39,-0.73),P=0.000 2];⑤5箇試驗(n=210)結果顯示,腹腔鏡組術後住院時間短于開腹組,其差異有統計學意義[WMD=-3.89,95%Cl(-5.54,-2.23),P<0.000 01];⑥5箇試驗(n=248)結果顯示,腹腔鏡組術後併髮癥率低于開腹組,其差異有統計學意義[OR=0.31,95%Cl(0.13,0.72),P=0.006];⑦2箇試驗(n=97)結果顯示,腹腔鏡組丙氨痠轉氨酶(ALT)低于開腹手術組,其差異有統計學意義[SMD=-1.154,95%Cl(-207,-1.01),P<0.000 01].結論 腹腔鏡肝癌切除術作為一種微創技術,與開腹肝癌切除術相比具有腹壁切口較小,術中齣血量較少,住院時間短,術後併髮癥率低等優點,有利于提高病人的生活質量.因本繫統評價納入的病例數較少,且納入均為非隨機對照試驗,無法確定偏倚對結論可靠性的影響程度.因此上述結論尚需謹慎對待,有必要開展和設計大樣本隨機對照研究來進一步驗證.
목적 계통평개복강경여개복수술절제치료간암적근기료효급안전성.방법 계산궤검색MEDLINE(1966～2008.3)、Embase(1966～2008.3)、Coehrane도서관(2008년제1기)화중국생물의학문헌수거고(1979～2008.3),수공검색여간암치료상관적<중화종류잡지>등중문기간,수집복강경절제여개복절제비교치료간암적수궤대조시험화림상대조시험.문헌질량평개채용Deeks JJ평개표준,수거제취화문헌질량평개유량명평개원독립진행.채용Cochrane협작망전용연건RevMan 4.2.10대수거진행통계분석.결과 미획득수궤대조시험,공납입7개림상동기대조시험,합계309례환자.Meta분석결과현시:①주원기간병사솔:4개시험(n=198)표명,복강경조여개복절제조비교,량조차이무통계학의의[OR=1.14,95%CI(0.15,8.65),P=0.90];②2개시험(n=91)보도료술중수혈솔,량조차이무통계학의의[OR=0.20,95%CI(0.03,1.19),P=0.08];③4개시험(n=165)결과현시,복강경조간암절제수술시간장우개복조,기차이유통계의의[SMD=1.05,95%Cl (0.72,1.38),P<0.00001];④4개시험(n=165)결과현시,복강경조술중출혈량저우개복조,기차이유통계학의의[SMD=-1.56,95%Cl(-2.39,-0.73),P=0.000 2];⑤5개시험(n=210)결과현시,복강경조술후주원시간단우개복조,기차이유통계학의의[WMD=-3.89,95%Cl(-5.54,-2.23),P<0.000 01];⑥5개시험(n=248)결과현시,복강경조술후병발증솔저우개복조,기차이유통계학의의[OR=0.31,95%Cl(0.13,0.72),P=0.006];⑦2개시험(n=97)결과현시,복강경조병안산전안매(ALT)저우개복수술조,기차이유통계학의의[SMD=-1.154,95%Cl(-207,-1.01),P<0.000 01].결론 복강경간암절제술작위일충미창기술,여개복간암절제술상비구유복벽절구교소,술중출혈량교소,주원시간단,술후병발증솔저등우점,유리우제고병인적생활질량.인본계통평개납입적병례수교소,차납입균위비수궤대조시험,무법학정편의대결론가고성적영향정도.인차상술결론상수근신대대,유필요개전화설계대양본수궤대조연구래진일보험증.
Objective To evaluate the efficiency and safety of laparoscopic hepatectomy (LH) and conventional open hepatectomy (OH) in patients with hepatocellular carcinoma (HCC). Methods We searched The Cochrane Library, MEDLINE (1966～2008.3), EMBASE (1966～2008.3), CBM (1979～2008.3), we also handsearched some Chinese journals. Using a defined search strategy, randomized controlled trails and controlled clinical trials of comparing OH with LH for hepatocellular carcinoma were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trails was evaluated by Deeks ll's evaluation criterion. Meta-analysis was done using the Cochrane collaboration's Revman 4.2.10. Results Seven controlled clinical trials (309 patients) were included, The meta-analysis showed that: (1) Four studies (n= 198) reported mortality, the mortality rate of the LH group was not significantly different from that of the OH group [OR=1.14, 95%C1 (0.15, 8.65), P=0.90]; (2) Two studies (n=91) reported blood transfusion. There were no significant differences between the two treatment groups in terms of the blood transfusion [OR=0.20, 95%Cl (0.03, 1.19), P=0.08]; (3) Four studies (n=165) reported operation time. There were significant differences in operating time between the two groups [SMD=1.05, 95%CI (0.72, 1.38), P<0.000 01]; (4) Four studies (n=165) reported intraoperative blood loss. There were significant differences in intraoperative blood loss between the two groups [SMD= -1.56, 95%Cl (-2.39, -0.73), P=0.000 2]; (5) Five studies (n=210) reported the duration of hospital stay. There were significant differences in duration of hospital stay between the two groups [WMD= -3.89, 95%CI (-5.54, -2.23), P<0.000 01]; (6) Two studies (n=248) reported complications. There were significant differences in complications between the two groups [OR=0.31, 95%Cl (0.13, 0.72), P=0.006]; (7) Two studies (n=97) reported ALT. There were significant differences in ALT between the two groups [SMD= -1.54, 95%C1 (-207, -1.01), P<0.000 01]. Conclusion LH is associated with less postoperative complications, operative blood loss, duration of hospital stay and lower ALT, but longer operation time. However, the trails available for this systematic review are limited, so a prospective randomized controlled trial is warranted to fully investigate these and other outcome measures. ss
