微创肝切除与开腹肝切除治疗肝内结石的Meta分析

发布时间：2019-03-29 16:47

【摘要】：目的:评价微创肝切除治疗肝内结石的安全性和有效性。方法:计算机检索国内外数据库,收集比较微创肝切除与开腹肝切除治疗肝内结石的文献,提取有效数据后用Stata 12.0软件进行Meta分析。结果:最终纳入24篇相关文献,共有2 051例患者,其中993例行微创肝切除,1 058例行开腹肝切除。Meta分析结果显示,与开腹肝切除比较,微创肝切除术中出血量减少(SMD=-0.867,95%CI=-1.261~-0.472,P0.001)、输血率降低(OR=0.475,95%CI=0.330~0.683,P0.001)、术后并发症发生率降低(OR=0.493,95%CI=0.382~0.638,P0.001)、术后禁食时间缩短(SMD=-1.845,95%CI=-2.609~-1.082,P0.001)、术后住院时间减少(SMD=-0.983,95%CI=-1.323~-0.643,P0.001)、结石复发率降低(OR=0.513,95%CI=0.322~0.816,P=0.005),而两种手术方式的手术时间、术中结石清除率、最终结石清除率均无统计学差异(均P0.05)。结论:微创肝切除治疗肝内胆管结石是一种安全有效的手术方式,且多数术中、术后指标优于开腹手术,但仍需要更多临床随机对照试验进一步证实。
[Abstract]:Objective: to evaluate the safety and efficacy of minimally invasive hepatectomy for intrahepatic calculi. Methods: the literatures of minimally invasive hepatectomy and open hepatectomy for the treatment of intrahepatic calculi were collected and compared with the domestic and foreign databases. The effective data were extracted and analyzed by Meta software Stata 12.0. Results: twenty-one patients were included in 24 related literatures. Among them, 993 cases underwent minimally invasive hepatectomy and 1,058 cases underwent open hepatectomy. Meta-analysis showed that the results were compared with those of open hepatectomy, and the results of meta-analysis showed that there were 2 051 patients who underwent minimally invasive hepatectomy and 1,058 open hepatectomy. Reduction of blood loss (SMD=-0.867,95%CI=-1.261~-0.472,P0.001), blood transfusion rate (OR=0.475,95%CI=0.330~0.683,P0.001) and postoperative complications (OR=0.493,95%CI=0.382~0.638,) during minimally invasive hepatectomy (OR=0.493,95%CI=0.382~0.638,) P0.001), shortened fasting time (SMD=-1.845,95%CI=-2.609~-1.082,P0.001) and postoperative hospital stay (SMD=-0.983,95%CI=-1.323~-0.643,P0.001). Stone recurrence rate decreased (OR=0.513,95%CI=0.322~0.816,P=0.005), but there was no significant difference in operation time, intraoperative stone clearance rate and final stone clearance rate between the two operation methods (P 0.05). Conclusion: minimally invasive hepatectomy is a safe and effective method for the treatment of intrahepatic cholelithiasis, and the postoperative index is better than that of open surgery, but more clinical randomized controlled trials are still needed to confirm the effect of minimally invasive hepatectomy on intrahepatic cholelithiasis.
【作者单位】：三峡大学人民医院普通外科;荆州市中心医院手术室;
【分类号】：R657.42

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