肝中叶切除与半肝切除治疗中央型肝细胞癌效果比较的Meta分析

余计赏; 吴帆; 谭国钳; 王百林

doi:10.3969/j.issn.1001-5256.2019.05.015

肝中叶切除与半肝切除治疗中央型肝细胞癌效果比较的Meta分析

DOI: 10.3969/j.issn.1001-5256.2019.05.015

暨南大学医学院附属广州红十字会医院广州市红十字会医院肝胆外科

基金项目:

国家自然科学基金项目(81000989)；广东省医学科学技术研究基金项目(A2017517)；广州市卫生计生科技项目(20171A011250)；

详细信息

中图分类号: R735.7
计量
- 文章访问数: 1278
- HTML全文浏览量: 33
- PDF下载量: 306
- 被引次数: 0
出版历程
- 收稿日期: 2018-12-19
- 出版日期: 2019-05-20

Clinical effect of mesohepatectomy versus hemihepatectomy in treatment of centrally located hepatocellular carcinoma: A Meta-analysis

Department of Hepatobiliary Surgery, Guangzhou Red Cross Hospital Affiliated to Medical College of Jinan University

Research funding:

摘要

摘要: 目的对肝中叶切除术和半肝切除术治疗中央型肝细胞癌的效果进行系统分析。方法通过计算机检索PubMed、EMBASE、Cochrane Library、中国知网、万方数据库和维普数据库中提供了肝中叶切除与半肝切除治疗中央型肝细胞癌对比研究的文献。提取手术时间、术中出血量、术后肝衰竭例数、围手术期病死率、总生存率和无瘤生存率等指标,并应用Review Manager 5. 3软件进行数据分析。各研究间的异质性采用χ2检验判断。二分类变量采用比值比（OR）分析,连续性变量采用加权均数差（WMD）分析,两类变量均计算95%可信区间（95%CI）。结果共纳入符合标准的文献10篇,均为回顾性病例对照研究,总样本量1861例,其中肝中叶切除组1054例,半肝切除组807例。Meta分析结果显示肝中叶切除组患者术后肝衰竭的发生率低于半肝切除组（OR=0. 37,95%CI:0. 16～0. 87,P=0. 02）;而手术时间（WMD=15. 17,95%CI:-18. 75～49. 05,P=0. 38）、术中出血量（WMD=100. 96,95%CI:-15. 29～217. 2...
- 癌,肝细胞 /
- 肝中叶切除术 /
- 半肝切除术 /
- 治疗结果 /
- Meta分析
Abstract: Objective To systematically review the clinical effect of mesohepatectomy versus hemihepatectomy in the treatment of centrally located hepatocellular carcinoma ( HCC) . Methods PubMed, EMBASE, Cochrane Library, CKNI, Wanfang Data, and VIP were searched for comparative studies on mesohepatectomy versus hemihepatectomy in the treatment of centrally located HCC. Related data were extracted, including time of operation, intraoperative blood loss, number of patients with postoperative liver failure, mortality rate in the perioperative period, overall survival rate, and disease-free survival rate, and Review Manager 5. 3 software was used for data analysis.The chi-square test was used to evaluate the heterogeneity between these studies. Odds ratio ( OR) was used for the analysis of binary variables, weighted mean difference ( WMD) was used for the analysis of continuous variables, and 95% confidence interval ( CI) was calculated for these variables. Results A total of 10 retrospective case-control studies which met the inclusion criteria were included, with a total sample size of 1861 patients ( 1054 in the mesohepatectomy group and 807 in the hemihepatectomy group) . The meta-analysis revealed that the mesohepatectomy group had a significantly lower incidence rate of postoperative liver failure than the hemihepatectomy group ( OR =0. 37, 95% CI: 0. 16-0. 87, P = 0. 02) , while there were no significant differences between the two groups in time of operation ( WMD =15. 17, 95% CI:-18. 75 to 49. 05, P = 0. 38) , intraoperative blood loss ( WMD = 100. 96, 95% CI:-15. 29 to 217. 21, P = 0. 09) , mortality rate in the perioperative period ( OR = 0. 55, 95% CI: 0. 26-1. 17, P = 0. 12) , incidence rate of bile leakage after surgery ( OR = 1. 32, 95% CI: 0. 74-2. 38, P = 0. 35) , overall survival rate, and disease-free survival rate. Conclusion Mesohepatectomy can significantly reduce the risk of postoperative liver failure. For patients with centrally located HCC and liver cirrhosis, experienced surgeons may give priority to mesohepatectomy.
- carcinoma, hepatocellular /
- mesohepatectomy /
- hemihepatectomy /
- treatment outcome /
- Meta-analysis

HTML全文

参考文献(24)

[1] CHEN W, SUN K, ZHENG R, et al. Cancer incidence and mortality in China, 2014[J]. Chin J Cancer Res, 2018, 30 (1) :1-12.

[2] SCUDAMORE CH, BUCZKOWSKI AK, SHAYAN H, et al. Mesohepatectomy[J]. Am J Surg, 2000, 179 (5) :356-360.

[3] STRATOPOULOS C, SOONAWALLA Z, BROCKMANN J, et al. Central hepatectomy:The golden mean for treating central liver tumors?[J]. Surg Oncol, 2007, 16 (2) :99-106.

[4] KATTEPUR AK, ROHITH S, SHIVASWAMY BS, et al. Mesohepatectomy:An emerging technique[J]. Indian J Surg Oncol, 2013, 4 (4) :345-348.

[5] LEE SY. Central hepatectomy for centrally located malignant liver tumors:A systematic review[J]. World J Hepatol, 2014, 6 (5) :347-357.

[6] ZENG XT, LIU H, CHEN X, et al. Meta analysis seriesⅣ:Quality assessment tool observational study[J]. Chin J Evid Based Cardiovasc Med, 2012, 4 (4) :297-299. (in Chinese) 曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四:观察性研究的质量评价工具[J].中国循证心血管医学杂志, 2012, 4 (4) :297-299.

[7] CHEN CH, HUANG TH, CHANG CC, et al. Central hepatectomy still plays an important role in treatment of early-stage centrally located hepatocellular carcinoma[J]. World J Surg, 2017, 41 (11) :2830-2837.

[8] CHEN X, LI B, HE W, et al. Mesohepatectomy versus extended hemihepatectomy for centrally located hepatocellular carcinoma[J]. Hepatobiliary Pancreat Dis Int, 2014, 13 (3) :264-270.

[9] CHENG CH, YU MC, WU TH, et al. Surgical resection of centrally located large hepatocellular carcinoma[J]. Biomed J, 2012, 35 (2) :178.

[10] HU R, LEE PH, CHANG YC, et al. Treatment of centrally located hepatocellular carcinoma with central hepatectomy[J].Surgery, 2003, 133 (3) :251-256.

[11] LI W, LI L, MINIGALIN D, et al. Anatomic mesohepatectomy versus extended hepatectomy for patients with centrally located hepatocellular carcinoma[J]. HPB (Oxford) , 2018, 20 (6) :530-537.

[12] WU CC, HO WL, CHEN JT, et al. Mesohepatectomy for centrally located hepatocellular carcinoma:An appraisal of a rare procedure[J]. J Am Coll Surg, 1999, 188 (5) :508-515.

[13] YANG LY, CHANG RM, LAU WY, et al. Mesohepatectomy for centrally located large hepatocellular carcinoma:Indications, techniques, and outcomes[J]. Surgery, 2014, 156 (5) :1177-1187.

[14] FAN J, ZHOU W, WU ZQ, et al. Surgical resection for centrally located hepatocellular carcinoma[J]. Chin J Dig Surg, 2007, 6 (1) :8-12. (in Chinese) 樊嘉, 周俭, 吴志全, 等.中央型肝癌的手术切除[J].中华消化外科杂志, 2007, 6 (1) :8-12.

[15] LU MS, HUANG ZD, LIU Q. Surgical treatment for centrally located hepatocellular carcinoma[J]. J Qiqihar Med Univ, 2011, 32 (14) :2278. (in Chinese) 卢茂松, 黄征焘, 刘强.中央区肝癌肝切除的手术治疗探讨[J].齐齐哈尔医学院学报, 2011, 32 (14) :2278.

[16] YAO JZ, HOU CW, DONG CP, et al. Experience of mesohepatectomy in the treatment of central primary hepatocellular carcinoma[J]. Chin Med Pharm, 2013, 3 (3) :175-176. (in Chinese) 姚竞智, 侯传伟, 董趁捧, 等.肝中叶切除治疗中央区原发性肝癌[J].中国医药科学, 2013, 3 (3) :175-176.

[17] XIAO Y, LI W, WAN H, et al. Central hepatectomy versus major hepatectomy for patients with centrally located hepatocellular carcinoma:A meta-analysis[J]. Int J Surg, 2018, 52:297-302.

[18] CHAN J, PERINI M, FINK M, et al. The outcomes of central hepatectomy versus extended hepatectomy:A systematic review and meta-analysis[J]. HPB (Oxford) , 2018, 20 (6) :487-496.

[19] RAHBARI NN, GARDEN OJ, PADBURY R, et al. Posthepatectomy liver failure:A definition and grading by the International Study Group of Liver Surgery (ISGLS) [J]. Surgery, 2011, 149 (5) :713-724.

[20] XU XL, WANG ZX, ZHOU Y, et al. Reconsideration of liver failure afer liver cancer surgery[J]. J Chin Hepatol, 2018, 34 (9) :2008-2011. (in Chinese) 许晓磊, 王志鑫, 周瀛, 等.对肝癌术后肝衰竭的再认识[J].临床肝胆病杂志, 2018, 34 (9) :2008-2011.

[21] LI J, WANG C, SONG J, et al. Mesohepatectomy versus extended hemihepatectomies for centrally located liver tumors:A Meta-analysis[J]. Sci Rep, 2017, 7 (1) :9329.

[22] YU WB, RAO A, VU V, et al. Management of centrally located hepatocellular carcinoma:Update 2016[J]. World J Hepatol, 2017, 9 (13) :627-634.

[23] YU W, RONG W, WANG L, et al. R1 hepatectomy with exposure of tumor surface for centrally located hepatocellular carcinoma[J]. World J Surg, 2014, 38 (7) :1777-1785.

[24] ISHII T, HATANO E, FURUYAMA H, et al. Preventive measures for postoperative bile leakage after central hepatectomy:A multicenter, prospective, observational study of 101 patients[J]. World J Surg, 2016, 40 (7) :1720-1728.

施引文献

资源附件(0)

访问统计