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中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (01) : 33 -37. doi: 10.3877/cma.j.issn.2095-3232.2021.01.008

所属专题: 文献

临床研究

腹腔镜与开腹左半肝切除术治疗肝内胆管结石安全性和疗效比较Meta分析
牛朝1, 李波1, 靳文帝1, 王春晓1, 李晓刚1,()   
  1. 1. 650021 昆明,云南省第二人民医院普外一科
  • 收稿日期:2020-09-20 出版日期:2021-02-10
  • 通信作者: 李晓刚
  • 基金资助:
    云南省卫健委医学后备人才计划项目(H-2018064)

Comparison of safety and efficacy between laparoscopic and open left hepatectomy in treatment of hepatolithiasis: a Meta-analysis

Chao Niu1, Bo Li1, Wendi Jin1, Chunxiao Wang1, Xiaogang Li1,()   

  1. 1. Department I of General Surgery, the Second People's Hospital of Yunnan Province, Kunming 650021, China
  • Received:2020-09-20 Published:2021-02-10
  • Corresponding author: Xiaogang Li
引用本文:

牛朝, 李波, 靳文帝, 王春晓, 李晓刚. 腹腔镜与开腹左半肝切除术治疗肝内胆管结石安全性和疗效比较Meta分析[J]. 中华肝脏外科手术学电子杂志, 2021, 10(01): 33-37.

Chao Niu, Bo Li, Wendi Jin, Chunxiao Wang, Xiaogang Li. Comparison of safety and efficacy between laparoscopic and open left hepatectomy in treatment of hepatolithiasis: a Meta-analysis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(01): 33-37.

目的

系统比较腹腔镜左半肝切除术(LLH)和开腹左半肝切除术(OLH)治疗肝内胆管结石的安全性和疗效。

方法

通过计算机检索PubMed、EMBASE、中国知网、万方数据库和维普数据库中2010年1月至2020年1月左半肝切除术治疗肝内胆管结石的文献。提取手术时间、术中出血量、住院时间、术后首次排气、术后下床时间、术后并发症等指标。采用Review Manager 5.3软件进行Meta分析。

结果

共纳入符合标准的文献11篇,均为临床随机对照试验研究,共773例,其中LLH组387例,OLH组386例。Meta分析显示,与OLH相比,LLH可明显缩短住院时间、术后排气时间和术后早期下床时间(MD=-3.27,-0.98,-1.20;P<0.05),降低术后并发症发生率和术后切口感染发生率(OR=0.39,0.31;P<0.05)。

结论

与OLH相比,LLH治疗肝内胆管结石具有住院时间短、术后并发症少和术后恢复快的优势,可加速患者术后康复。

Objective

To systematically compare the safety and efficacy between laparoscopic left hepatectomy (LLH) and open left hepatectomy (OLH) in the treatment of hepatolithiasis.

Methods

Literature related to left hepatectomy for hepatolithiasis between January 2010 to January 2020 were retrieved in database of PubMed, EMBASE, CNKI, Wanfang and VIP. Clinical parameters including operation time, intraoperative blood loss, length of hospital stay, time to initial anal exhaust, time to out-of-bed activity and postoperative complications were collected. Meta-analysis was conducted by using Review Manager 5.3 software.

Results

A total of 11 eligible articles were included, all of which were studies of clinical randomized controlled trials. Among 773 patients, 387 cases were allocated in the LLH group and 386 casesin the OLH group. Meta-analysis demonstrated that compared with OLH, LLH could significantly shorten the length of hospital stay, time to initial anal exhaust and time to out-of-bed activity (MD=-3.27, -0.98, -1.20; P<0.05), and remarkably lowered the incidence of postoperative complications and incisional infection (OR=0.39, 0.31; P<0.05).

Conclusions

Compared with OLH, LLH has multiple advantages of shorter length of hospital stay, less postoperative complications and faster postoperative recovery, which can accelerate postoperative rehabilitation of patients.

表1 纳入文献质量评价
图1 LLH组与OLH组肝内胆管结石患者手术时间的Meta分析
图2 文献发表性偏倚漏斗图
[1]
刘付宝, 耿小平. 肝内胆管结石的病因学研究[J]. 肝胆外科杂志, 2014, 22(3):227-230.
[2]
Co M, Pang SY, Wong KY, et al. Surgical management of recurrent pyogenic cholangitis:10 years of experience in a tertiary referral centre in Hong Kong[J]. HPB, 2014, 16(8):776-780.
[3]
Cai H, Kong WT, Chen CB, et al. Cholelithiasis and the risk of intrahepatic cholangiocarcinoma: a meta-analysis of observational studies[J]. BMC Cancer, 2015(15):831.
[4]
Lee SE, Jang JY, Lee JM, et al. Selection of appropriate liver resection in left hepatolithiasis based on anatomic and clinical study[J]. World J Surg, 2008, 32(3):413-418.
[5]
Yoon YS, Han HS, Shin SH, et al. Laparoscopic treatment for intrahepatic duct stones in the era of laparoscopy: laparoscopic intrahepatic duct exploration and laparoscopic hepatectomy[J]. Ann Surg, 2009, 249(2):286-291.
[6]
Brooke-Smith M, Figueras J, Ullah S, et al. Prospective evaluation of the International Study Group for Liver Surgery definition of bile leak after a liver resection and the role of routine operative drainage: an international multicentre study[J]. HPB, 2015, 17(1):46-51.
[7]
Shin YC, Jang JY, Kang MJ, et al. Comparison of laparoscopic versus open left-sided hepatectomy for intrahepatic duct stones[J].Surg Endosc, 2016, 30(1):259-265.
[8]
Zhou F, Shao JH, Zou SB, et al. Laparoscopic hepatectomy is associated with a higher incident frequency in hepatolithiasis patients[J]. Surg Today, 2013, 43(12):1371-1381.
[9]
Peng L, Xiao J, Liu Z, et al. Laparoscopic versus open left-sided hepatectomy for hepatolithiasis: a systematic review and meta-analysis[J]. J Laparoendosc Adv Surg Tech A, 2017, 27(9): 951-958.
[10]
Yin X, Luo D, Huang Y, et al. Advantages of laparoscopic left hemihepatectomy: a meta-analysis[J]. Medicine, 2019, 98(23): e15929.
[11]
Ding G, Cai W, Qin M. Pure laparoscopic versus open liver resection in treatment of hepatolithiasis within the left lobes: a randomized trial study[J]. Surg Laparosc Endosc Percutan Tech, 2015, 25(5): 392-394.
[12]
李典春. 腹腔镜解剖性肝左外叶切除术对肝内胆管结石的临床效果[J]. 中国卫生标准管理, 2019, 24(10):50-53.
[13]
李昆仑, 陈昕, 郑永光. 腹腔镜下微创左肝外叶切除术对肝内胆管结石患者肝功能的影响[J]. 医学理论与实践, 2018, 31(20): 3053-3055.
[14]
孙庆红. 解剖性左半肝切除治疗左肝内胆管结石的疗效与安全性分析[J]. 临床医学, 2017, 37(7):8-9.
[15]
吴涌宏, 李旭刚, 张耀明. 腹腔镜和开腹左半肝切除治疗左肝内胆管结石的临床疗效比较[J]. 泰山医学院学报, 2018, 39(1):55-56.
[16]
谢晓. 腹腔镜左肝外叶切除术在肝胆管结石治疗中的应用效果观察[J]. 中国医学装备, 2014, 11(1):95-97.
[17]
姚俊, 周宁杰. 腹腔镜与开腹左半肝切除术治疗肝胆管结石的疗效及预后比较[J]. 临床医药实践, 2016, 25(9):654-657.
[18]
尹晓庆, 崔宏伟. 腹腔镜肝切除术在左肝内胆管结石治疗中的临床应用[J]. 浙江临床医学, 2015(9):1502-1504.
[19]
张福庆. 腹腔镜左肝外叶切除的临床应用研究[J]. 基层医学论坛, 2017, 21(4):388-389.
[20]
周舟. 腹腔镜左肝外叶切除术在肝胆管结石治疗中的应用效果观察[J]. 现代诊断与治疗, 2014, 25(18):4286-4287.
[21]
皇甫行勋. 腹腔镜解剖性肝左外叶切除术治疗肝内胆管结石[J]. 牡丹江医学院学报, 2018, 39(4):64-65, 90.
[22]
尚敏杰, 张成武. 肝内胆管结石的微创治疗进展[J]. 肝胆胰外科杂志, 2016, 28(5):436-438.
[23]
Tan J, Tan Y, Chen F, et al. Endoscopic or laparoscopic approach for hepatolithiasis in the era of endoscopy in China[J]. Surg Endosc, 2015, 29(1):154-162.
[24]
Isik A, Idiz O, Firat D. Novel approaches in pilonidal sinus treatment[J]. Prague Med Rep, 2016, 117(4):145-152.
[25]
Reich H, McGlynn F, DeCaprio J, et al. Laparoscopic excision of benign liver lesions[J]. Obstet Gynecol, 1991, 78(5 Pt 2):956-958.
[26]
Ciria R, Cherqui D, Geller DA, et al. Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing[J]. Ann Surg, 2016, 263(4):761-777.
[27]
Cai X, Duan L, Wang Y, et al. Laparoscopic hepatectomy by curettage and aspiration: a report of 855 cases[J]. Surg Endosc, 2016, 30(9):4161.
[28]
Jin RA, Wang Y, Yu H, et al. Total laparoscopic left hepatectomy for primary hepatolithiasis: eight-year experience in a single center[J]. Surgery, 2016, 159(3):834-841.
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