半肝阻断法和全肝阻断法在原发性肝癌肝切除术中应用效果比较的Meta分析

刘莹; 高本见; 杨小李; 方程; 苏松; 李波

doi:10.3969/j.issn.1001-5256.2021.01.015

半肝阻断法和全肝阻断法在原发性肝癌肝切除术中应用效果比较的Meta分析

DOI: 10.3969/j.issn.1001-5256.2021.01.015

西南医科大学附属医院肝胆外科，四川省院士(专家)工作站，四川泸州 646000

基金项目:

国家自然科学基金资助项目 (81802778)

利益冲突声明：本研究不存在研究者以及与公开研究成果有关的利益冲突，特此声明。

作者贡献声明：刘莹、高本见负责课题设计，收集数据，资料分析，撰写论文；杨小李、方程、苏松参与修改论文；李波负责指导撰写文章并最后定稿。

详细信息

作者简介:
刘莹(1995—)，女，主要从事肝胆外科临床研究

通信作者:
李波，liboer2002@126.com

中图分类号: R735.7
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- 文章访问数: 834
- HTML全文浏览量: 220
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- 被引次数: 0
出版历程
- 收稿日期: 2020-08-06
- 录用日期: 2020-08-21
- 出版日期: 2021-01-20

Effect of hemihepatic vascular exclusion versus total hepatic vascular exclusion in hepatectomy for primary liver cancer: A Meta-analysis

Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University; Academician (Expert) Workstation of Sichuan Province, Luzhou, Sichuan 646000, China

摘要

摘要: 目的比较普林格尔法(Pringle’s measure, PM)和半肝血管流入阻断法(HVO)在原发性肝癌肝切除术中的应用效果。方法计算机检索中、英文数据库中关于HVO和PM治疗原发性肝癌的对照研究，查找时间为数据库建立至2020年6月。对纳入的研究进行质量评价和数据提取后，采用RevMan5.3软件进行Meta分析。结果共纳入10项研究，合计1272例患者。HVO组术后第1、3天ALT水平低于PM组[均数差(MD)=-172.71，95%CI：-289.26~-56.16，P=0.004；MD=-130.35，95%CI：-221.25~-39.45，P=0.005]，术后第3天AST水平低于PM组(MD=-84.56，95%CI：-166.47~-2.65，P=0.04)，术后第1、3天Alb水平高于PM组(MD=1.31，95%CI：0.06~2.56，P=0.04；MD=1.81，95%CI：0.27~3.35，P=0.02)，手术时间较PM组长(MD=8.95，95%CI：4.30~13.60；P＜0.01)。结论 HVO是一种安全有效的血流阻断方法，与PM相比能有效减轻肝损伤。但外科医生还应根据个人经验、患者病情以及术中具体情况选择适合患者的阻断方法。
- 肝肿瘤 /
- 阻断治疗 /
- 肝切除术 /
- Meta分析(主题)
Abstract: Objective To systematically evaluate the effect of Pringle's measure (PM) versus hemihepatic vascular occlusion (HVO) in hepatectomy for primary liver cancer. Methods Related Chinese and English databases were searched for control studies on HVI versus PM in the treatment of primary liver cancer published up to June 2020. After quality evaluation and data extraction of the included studies, RevMan5.3 software was used for the meta-analysis. Results A total of 10 studies were included in the Meta-analysis, with 1272 patients in total. On days 1 and 3 after surgery, the HVO group had a significantly lower level of alanine aminotransferase than the PM group (day 1: mean difference [MD]=-172.71, 95% confidence interval [CI]: -289.26 to -56.16, P=0.004; day 3: MD=-130.35, 95%CI: -221.25 to -39.45, P=0.005). On day 3 after surgery, the HVO group had a significantly lower level of aspartate aminotransferase than the PM group (MD=-84.56, 95%CI: -166.47 to -2.65, P=0.04), and on days 1 and 3 after surgery, the HVO group had a significantly higher level of albumin than the PM group (day 1: MD=1.31, 95%CI: 0.06-2.56, P=0.04; day 3: MD=1.81, 95%CI: 0.27-3.35, P=0.02). The HVO group had a significantly longer time of operation than the PM group (MD=8.95, 95%CI: 4.30-13.60, P < 0.01). Conclusion HVO is a safe and effective method for vascular occlusion, and compared with PM, it can effectively alleviate liver injury. However, surgeons should select a suitable method for occlusion based on their own personal experience, patients' conditions, and specific situation during surgery.
- Liver Neoplasms /
- Therapeutic Occlusion /
- Hepatectomy /
- Meta-Analysis as Topic

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图 1 文献筛选流程图

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图 2 2组术后第1、3、5天ALT水平的Meta分析

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图 3 2组术后第1、3、5天AST水平的Meta分析

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图 4 2组术后第1、3、5天Alb水平的Meta分析

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图 5 2组术后第1、3、5天TBil水平的Meta分析

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图 6 2组手术时间的Meta分析

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图 7 2组术中出血量的Meta分析

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图 8 2组术中输血率的Meta分析

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图 9 2组术后总体并发症的Meta分析

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图 10 2组住院时间的Meta分析

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表 1 纳入文献基本特征及质量评价

作者	年份	国家	研究类型	手术分组	样本量(例)	年龄(岁)	男/女(例)	肿瘤大小(cm)	质量评分(NOS/Jadad量表)
Huang等^[13]	2014	中国	RCS	HVO	126	49.3±12.8	97/29	-	8
				PM	158	48.5±12.0	129/29	-
Li等^[14]	2017	中国	RCS	HVO	26	53(34~72)¹⁾	20/6	-	8
				PM	37	47.5(25~70)¹⁾	33/4	-
Ni等^[15]	2013	中国	RCT	HVO	60	56.1±9.3	47/13	4.7±2.2	3
				PM	60	55.2±8.7	45/15	5.4±3.1
Fu等^[16]	2011	中国	RCT	HVO	60	49.3±9.2	41/19	6±2.8	3
				PM	60	48.6±8.7	46/14	6.8±2.8
蔡鸿宇等^[17]	2019	中国	RCT	HVO	76	54.11±7.75	59/17	5.03±2.86	3
				PM	76	53.24±7.83	56/20	5.77±3.74
曾三平^[18]	2020	中国	RCT	HVO	40	48.6±3.1	22/18	-	3
				PM	40	48.8±3.0	23/17	-
韩玉龙等^[19]	2018	中国	RCS	HVO	44	-	-	10.1±3.1	7
				PM	52	-	-	9.6±3.0
乔海军等^[20]	2018	中国	RCS	HVO	54	57.35±9.06	35/19	6.47±1.42	8
				PM	70	56.94±8.72	46/24	6.51±1.38
吴宗杨等^[21]	2014	中国	RCT	HVO	35	-	-	-	3
				PM	35	-	-	-
庄盛威等^[22]	2018	中国	RCS	HVO	31	49.62±4.91	24/7	9.07±0.99	8
				PM	42	49.09±4.51	32/10	9.31±0.75
注：1)M(P_最小值~P_最大值)；“-”表示未提及。

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