切换至 "中华医学电子期刊资源库"
高级检索
中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2018, Vol. 07 ›› Issue (05) : 385 -390. doi: 10.3877/cma.j.issn.2095-3232.2018.05.010

所属专题： 文献；

临床研究

腹腔镜肝囊型包虫病手术疗效评价Meta分析
阿不都克衣木·牙生1, 古力加乃提·麦麦吐逊2, 艾尔夏提·依布拉音1, 阿布都萨拉木·米吉提1, 卡哈尔·吐尔逊1, 徐祺林1,†()   
  1. 1. 844000　新疆维吾尔自治区喀什地区第一人民医院普通外科二科　新疆维吾尔自治区包虫病研究所喀什地区分所
    2. 844000　新疆维吾尔自治区喀什地区第一人民医院神经内科
  • 收稿日期:2018-07-09 出版日期:2018-10-10
  • 通信作者: 徐祺林

Meta-analysis of clinical efficacy of laparoscopic surgery for hepatic cystic echinococcosis

Yasheng Abudoukeyimu1, Maimaituxun Gulijianaiti2, Yibulayin Aierxiati1, Mijiti Abudousalamu1, Tuerxun Kahaer1, Qilin Xu1,†()   

  1. 1. Department Ⅱ of General Surgery, the First People's Hospital of Kashi Prefecture, Xinjiang Uygur Autonomous Region, Kashi 844000, China
    2. Department of Neurology, the First People's Hospital of Kashi Prefecture, Xinjiang Uygur Autonomous Region, Kashi 844000, China
  • Received:2018-07-09 Published:2018-10-10
  • Corresponding author: Qilin Xu
  • About author:
    Corresponding author: Xu Qilin, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

阿不都克衣木·牙生, 古力加乃提·麦麦吐逊, 艾尔夏提·依布拉音, 阿布都萨拉木·米吉提, 卡哈尔·吐尔逊, 徐祺林. 腹腔镜肝囊型包虫病手术疗效评价Meta分析[J]. 中华肝脏外科手术学电子杂志, 2018, 07(05): 385-390.

Yasheng Abudoukeyimu, Maimaituxun Gulijianaiti, Yibulayin Aierxiati, Mijiti Abudousalamu, Tuerxun Kahaer, Qilin Xu. Meta-analysis of clinical efficacy of laparoscopic surgery for hepatic cystic echinococcosis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(05): 385-390.

目的

探讨腹腔镜肝脏囊型包虫病手术治疗的临床疗效及安全性。

方法

在Pubmed、Cochrane Library、万方医学等检索平台检索1992年1月至2017年11月文献，关键词为"肝囊型包虫病"、"包虫病"、"手术"、"腹腔镜"、"微创手术"、"echinococcosis"，"liver or hepatic"，"surgery"，"open"，"laparoscopic or minimal invasive"。对纳入研究的文献中关于治疗效果、并发症、住院时间、复发率相关数据进行提取并进行Meta分析。

结果

纳入文献共8篇，其中6篇回顾性病例对照研究，2篇前瞻性研究。共1 075例患者，腹腔镜组238例，开腹手术组837例。Meta分析结果显示腹腔镜组有较低的术后并发症发生率（OR=0.58，95%CI：0.38～0.87，P<0.05），较少的切口相关并发症（OR=0.34，95%CI：0.13～0.91，P<0.05），较短的住院时间（MD=-3.61，95%CI：-4.84～-2.38，P<0.05）。两组术后胆漏、残腔感染及积液、术后复发率比较差异无统计学意义（OR=0.87，0.51，0.50；P>0.05）。

结论

腹腔镜肝囊型包虫手术是安全的，可以达到和开腹手术相同的疗效。与开腹手术相比，其具有术后切口相关并发症发生率低和住院时间短等优势。

关键词: 棘球蚴病，肝, 腹腔镜, 外科手术, 疗效比较研究, 围手术期医护
Objective

To investigate the clinical efficacy and safety of laparoscopic surgery in the treatment of hepatic cystic echinococcosis.

Methods

Literatures published from January 1992 to November 2017 were retrieved in database of PubMed, Cochrane Library and Wanfang data, etc. The searching keywords included hepatic cystic echinococcosis, echinococcosis, surgery, laparoscope, minimally invasive surgery, living or hepatic, open, laparoscopic or minimal invasive in both Chinese and English. Clinical data related to therapeutic effect, complications, length of hospital stay and recurrence rate were extracted for Meta-analysis from the included literatures.

Results

A total of 8 articles were eligible including 6 retrospective case-control studies and 2 prospective studies. A total of 1 075 cases were recruited including 238 cases in laparoscopic surgery group and 837 in open surgery group. In laparoscopic surgery group, the incidence of postoperative complications was significantly lower (OR=0.58, 95%CI: 0.38-0.87, P<0.05), the incidence of incision-related complications was significantly lower (OR=0.34, 95%CI: 0.13-0.91, P<0.05) and the length of hospital stay was significantly shorter (MD=-3.61, 95%CI: -4.84 to -2.38, P<0.05) compared with those in open surgery group. No significant difference was observed in the incidence of postoperative bile leakage, residual cavity infection, hydrops and recurrence rate between two groups (OR=0.87, 0.51, 0.50; P>0.05).

Conclusions

Laparoscopic surgery is safe for cystic echinococcosis, it can achieve the same effect as open surgery. Compared with open surgery, laparoscopic surgery has the advantages of lower incidence of postoperative incision-related complications and shorter length of hospital stay.

Key words: Echinococcosis, hepatic, Laparoscopes, Surgical procedures, operative, Comparative effectiveness research, Perioperative care
表1 纳入研究的文献基本信息
作者 年份 类型 总例数 腹腔镜手术 开腹手术 男 女 年龄（岁）
Yagci等[10] 2005 回顾性 215 30 185 137 078 35.2±13.3(10～73)
Busi?等[11] 2011 前瞻性 025 05 020 011 014 47(16～78)
Polat等[12] 2012 回顾性 019 07 012 007 012 31.7
Tuxun等[6] 2013 回顾性 353 60 293 207 146 -
Zaharie等[13] 2013 回顾性 231 59 172 097 134 43.8
马建忠等[14] 2014 回顾性 076 26 050 047 029 55.6
Bostanci等[15] 2015 回顾性 083 14 069 047 036 41.6±10.5(16～67)
Jabbari Nooghabi等[16] 2015 前瞻性 073 37 036 024 049 38.97±16.48
图1 纳入Meta分析的肝囊型包虫病患者术后总并发症发生率森林图
图2 不同分型肝包虫病患者在两种手术方式中占比
[1]
Bresson-Hadni S, Vuitton DA, Bartholomot B, et al. A twenty-year history of alveolar echinococcosis: analysis of a series of 117 patients from eastern France[J]. Eur J Gastroenterol Hepatol, 2000, 12(3): 327-336.
[2]
Dziri C, Haouet K, Fingerhut A. Treatment of hydatid cyst of the liver: where is the evidence?[J]. World J Surg, 2004, 28(8):731-736.
[3]
Katkhouda N, Fabiani P, Benizri E, et al. Laser resection of a liver hydatid cyst under videolaparoscopy[J]. Br J Surg, 1992, 79(6):560-561.
[4]
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration[J]. BMJ, 2009(339):b2700.
[5]
Guyatt G, Vist G, Falck-Ytter Y, et al. An emerging consensus on grading recommendations?[J]. ACP J Club, 2006, 144(1):A8-9.
[6]
Tuxun T, Aji T, Tai QW, et al. Conventional versus laparoscopic surgery for hepatic hydatidosis: a 6-year single-center experience[J]. J Gastrointest Surg, 2014, 18(6):1155-1160.
[7]
马尔旦·马合木提，邰沁文，吐尔干艾力·阿吉，等．肝脏囊型包虫病腹腔镜与开腹根治性手术治疗的疗效比较[J]．中华普通外科杂志，2014，29(12):941-944.
[8]
Gharbi HA, Hassine W, Brauner MW, et al. Ultrasound examination of the hydatic liver[J]. Radiology, 1981, 139(2):459-463.
[9]
WHO Informal Working Group. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings[J]. Acta Trop, 2003, 85(2):253-261.
[10]
Yagci G, Ustunsoz B, Kaymakcioglu N, et al. Results of surgical, laparoscopic, and percutaneous treatment for hydatid disease of the liver: 10 years experience with 355 patients[J]. World J Surg, 2005, 29(12):1670-1679.
[11]
Busić Z, Cupurdija K, Servis D, et al. Surgical treatment of liver echinococcosis--open or laparoscopic surgery?[J]. Coll Antropol, 2012, 36(4):1363-1366.
[12]
Polat FR. Hydatid cyst: open or laparoscopic approach? a retrospective analysis[J]. Surg Laparosc Endosc Percutan Tech, 2012, 22(3):264-266.
[13]
Zaharie F, Bartos D, Mocan L, et al. Open or laparoscopic treatment for hydatid disease of the liver? a 10-year single-institution experience[J]. Surg Endosc, 2013, 27(6):2110-2116.
[14]
马建忠，张有成，侯朝福，等．腹腔镜与开腹肝包虫内囊摘除术的临床对照研究[J]．医学与哲学，2014(18):24-25.
[15]
Bostanci O, Kartal K, Yazici P, et al. Laparoscopic versus open surgery for hydatid disease of the liver. a single center experience[J]. Ann Ital Chir, 2016(87):237-241.
[16]
Jabbari Nooghabi A, Mehrabi Bahar M, Asadi M, et al. Evaluation and comparison of the early outcomes of open and laparoscopic surgery of liver hydatid cyst[J]. Surg Laparosc Endosc Percutan Tech, 2015, 25(5):403-407.
[17]
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new prposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Ann Surg, 2004, 240(2):205-213.
[18]
Franchi C, Di Vico B, Teggi A. Long-term evaluation of patients with hydatidosis treated with benzimidazole carbamates[J]. Clin Infect Dis, 1999, 29(2):304-309.
[19]
Smego RA Jr, Bhatti S, Khaliq AA, et al. Percutaneous aspiration-injection-reaspiration drainage plus albendazole or mebendazole for hepatic cystic echinococcosis: a meta-analysis[J]. Clin Infect Dis, 2003, 37(8):1073-1083.
[20]
Khuroo MS, Dar MY, Yattoo GN, et al. Percutaneous drainage versus albendazole therapy in hepatic hydatidosis: a prospective, randomized study[J]. Gastroenterology, 1993, 104(5):1452-1459.
[21]
Dervenis C, Delis S, Avgerinos C, et al. Changing concepts in the management of liver hydatid disease[J]. J Gastrointest Surg, 2005, 9(6):869-877.
[22]
Bickel A, Daud G, Urbach D, et al. Laparoscopic approach to hydatid liver cysts. is it logical? physical, experimental, and practical aspects[J]. Surg Endosc, 1998, 12(8):1073-1077.
[23]
Aydin U, Yazici P, Onen Z, et al. The optimal treatment of hydatid cyst of the liver: radical surgery with a significant reduced risk of recurrence[J]. Turk J Gastroenterol, 2008, 19(1):33-39.
[24]
Tai QW, Tuxun T, Zhang JH, et al. The role of laparoscopy in the management of liver hydatid cyst: a single-center experience and world review of the literature[J]. Surg Laparosc Endosc Percutan Tech, 2013, 23(2): 171-175.
[25]
Tuxun T, Zhang JH, Zhao JM, et al. World review of laparoscopic treatment of liver cystic echinococcosis--914 patients[J]. Int J Infect Dis, 2014(24):43-50.
[26]
Bickel A, Loberant N, Singer-Jordan J, et al. The laparoscopic approach to abdominal hydatid cysts: a prospective nonselective study using the isolated hypobaric technique[J]. Arch Surg, 2001, 136(7):789-795.
[27]
Dervisoglu A, Polat C, Hokelek M, et al. Videolaparoscopic treatment of hepatic hydatid cyst[J]. Hepatogastroenterology, 2005, 52(65):1526-1528.
[28]
Tekant Y, Bilge K, Acarli K, et al. Endoscopic sphincterotomy in the treatment of postoperative biliary fistulas of hepatic hydatid disease[J]. Surg Endosc, 1996, 10(9):901-911.
[29]
McManus DP, Zhang W, Li J, et al. Echinoccoccosis[J]. Lancet, 2003, 362(9392):1295-1304.
[30]
Seven R, Berber E, Mercan S, et al. Laparoscopic treatment of hepatic hydatid cysts[J]. Surgery, 2000, 128(1):36-40.
[31]
中国医师协会外科医师分会包虫病外科专业委员会．肝两型包虫病诊断与治疗专家共识(2015版)[J]．中华消化外科杂志，2015，14(4):253-264.
[32]
Neugebauer EA, Morino M, Habermalz B. Surgical research or comic opera? let's give answers![J]. Surg Endosc, 2008, 22(6):1411-1412.
[1] 刘林峰, 王增涛, 王云鹏, 钟硕, 郝丽文, 仇申强, 陈超. 足底内侧皮瓣联合甲骨皮瓣在手指V度缺损再造中的临床应用[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 480-484.
[2] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[3] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[4] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[5] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[6] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[7] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[8] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[9] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[10] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[11] 李三祥, 李佳, 刘俊峰, 吕东晨, 方晖东, 谭朝晖, 刘杰, 潘佐, 乔建坤. 基于CT影像的三维重建成像技术在腹腔镜大肾上腺肿瘤切除术中的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 570-574.
[12] 林文斌, 郑泽源, 郑文能, 郁毅刚. 外伤性脾破裂腹腔镜脾切除术患者中转开腹风险预测模型构建[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 619-623.
[13] 牛朝, 李波, 张万福, 靳文帝, 王春晓, 李晓刚. 腹腔镜袖状胃切除联合胆囊切除治疗肥胖合并胆囊结石安全性和疗效[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 635-639.
[14] 孙秀艳, 徐庆蕾, 马鹏涛, 胡志元, 郭传真, 祝成红. 腹腔镜胃癌根治术中患者体温变化与压力性损伤及受压部位微环境的相关性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 480-484.
[15] 程相阵. 腹茧症9例诊治分析并文献复习[J]. 中华临床医师杂志(电子版), 2023, 17(9): 968-971.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号