ALPPS与PVE两步肝切除术的Meta分析
发布时间：2018-10-10 06:44
【摘要】：目的:系统的对比评价ALPPS与PVE在部分肝脏切除手术的疗效性和安全性的荟萃分析;为中晚期肝脏剩余体积不足的肿瘤患者选择手术方式提供理论依据。方法:检索Pubmed、Medline、Cochrane library、Embase、WOS-SCI、CMB、CNKI、VIP各数据库,收集关于ALPPS与PVE的临床对照研究,检索时间均为建库至2017年01月,依据纳入标准以及排除标准对检索到的文献筛选,筛选后的提取相关数据,同时进行评价质量,使用Review Manager 5.3软件对数据进行分析。结果:最终纳入7篇文献研究,总共525例患者,其中ALPPS组126例,PVE组399例。总分析后结果如下:(1)FLR(future liver remnant,残余肝体积)增生率,ALPPS组与PVE组有的统计学差异(MD=10.06,95%CI=7.60-13.61,P0.00001);(2)FLR每日增长速度,ALPPS组与PVE组术后FLR每日增长速度有显著的统计学差异(MD=31.54,95%CI=29.14-33.99,P0.00001);(3)两步肝切除手术完成率,ALPPS组与PVE组两步肝切除手术完成率有统计学差异(RR=9.34,95%CI=2.54-34.37,P=0.0008);(4)术后总并发症,ALPPS组与PVE组无统计学差异(RR=1.37,95%CI=0.93-2.03,P=0.12);(5)术后败血症,ALPPS组与PVE组术后败血症发生率无统计学差异(RR=8.56,95%CI=0.24-303.45,P=0.24);(6)术后胆漏,ALPPS组与PVE组术后胆漏发生率的无统计学差异(RR=2.12,95%CI=1.00-4.50,P=0.05);(7)术后肝功能衰竭,ALPPS组与PVE组无统计学差异(RR=0.85,95%CI=0.38-1.89,P=0.69);(8)住院日,ALPPS组与PVE组住院日有统计学差异(MD=-23.45,95%CI=-28.90--18.01,P0.00001);(9)R0(radical 0,根治性)切除率,ALPPS组与PVE组R0切除率有统计学差异(RR=2.99,95%CI=1.33-6.75,P=0.008);(10)90天死亡率,ALPPS组与PVE组90天死亡率无统计学差异(RR=1.94,95%CI=0.85-4.39,P=0.11)。结论:ALPPS手术组与PVE组在FLR增长率、每日FLR增长速度、两步肝切除手术完成率、住院日、R0切除中ALPPS组优于PVE组;在术后总并发症发生率以及术后(败血症、胆漏、肝功能衰竭、90天死亡率)中两者无明显统计学差异。
[Abstract]:Objective: to compare and evaluate the efficacy and safety of ALPPS and PVE in partial hepatectomy, and to provide theoretical basis for the choice of surgical methods for patients with liver residual volume deficiency in middle and late stage. Methods: the Pubmed,Medline,Cochrane library,Embase,WOS-SCI,CMB,CNKI,VIP databases were searched, and the clinical comparative studies on ALPPS and PVE were collected. The retrieval time was built to January 2017. According to the inclusion criteria and exclusion criteria, the retrieved literature was screened, and the relevant data were extracted after screening. At the same time, the quality was evaluated and the data were analyzed with Review Manager 5.3 software. Results: a total of 525 patients were included in 7 literature studies, including ALPPS group (n = 126) and PVE group (n = 399). The results of total analysis were as follows: (1) the proliferation rate of) FLR (future liver remnant, residual liver was significantly different from that of PVE group (MD=10.06,95%CI=7.60-13.61,P0.00001); (2) FLR daily growth rate was significantly higher than that of ALPPS group and PVE group (MD=31.54,95%CI=29.14-33.99,P0.00001); (3). There was no significant difference in the total postoperative complications between the RR=9.34,95%CI=2.54-34.37,P=0.0008); (group and the PVE group (RR=1.37,95%CI=0.93-2.03,P=0.12); (5). There was no significant difference in the incidence of postoperative septicemia between the ALPPS group and the PVE group (RR=8.56,95%CI=0.24-303.45,P=0.24); (6). There was no significant difference in the incidence of postoperative biliary leakage between the ALPPS group and the PVE group (RR=2.12,95%CI=1.00-4.50,P=0.05); (7). There was no significant difference (RR=0.85,95%CI=0.38-1.89,P=0.69); (8) between the ALPPS group and the PVE group (RR=0.85,95%CI=0.38-1.89,P=0.69); (8). There was a significant difference (MD=-23.45,95%CI=-28.90--18.01,P0.00001); (9) R0 (radical 0, radical) resection rate between the ALPPS group and the PVE group. The death rate of R0 in PVE group was significantly different (RR=2.99,95%CI=1.33-6.75,P=0.008); (10). There was no significant difference in 90 day mortality rate (RR=1.94,95%CI=0.85-4.39,P=0.11) between ALPPS group and PVE group. Conclusion the growth rate of FLR, the growth rate of daily FLR, the rate of completion of two-step hepatectomy, the rate of complete hepatectomy in the ALPPS group and the PVE group were better than those in the PVE group, and the incidence of postoperative complications and postoperative (septicemia, biliary leakage) were higher in the ALPPS group than in the PVE group. There was no significant difference between the two groups in 90 days mortality of liver failure.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7
本文编号：2261029
[Abstract]:Objective: to compare and evaluate the efficacy and safety of ALPPS and PVE in partial hepatectomy, and to provide theoretical basis for the choice of surgical methods for patients with liver residual volume deficiency in middle and late stage. Methods: the Pubmed,Medline,Cochrane library,Embase,WOS-SCI,CMB,CNKI,VIP databases were searched, and the clinical comparative studies on ALPPS and PVE were collected. The retrieval time was built to January 2017. According to the inclusion criteria and exclusion criteria, the retrieved literature was screened, and the relevant data were extracted after screening. At the same time, the quality was evaluated and the data were analyzed with Review Manager 5.3 software. Results: a total of 525 patients were included in 7 literature studies, including ALPPS group (n = 126) and PVE group (n = 399). The results of total analysis were as follows: (1) the proliferation rate of) FLR (future liver remnant, residual liver was significantly different from that of PVE group (MD=10.06,95%CI=7.60-13.61,P0.00001); (2) FLR daily growth rate was significantly higher than that of ALPPS group and PVE group (MD=31.54,95%CI=29.14-33.99,P0.00001); (3). There was no significant difference in the total postoperative complications between the RR=9.34,95%CI=2.54-34.37,P=0.0008); (group and the PVE group (RR=1.37,95%CI=0.93-2.03,P=0.12); (5). There was no significant difference in the incidence of postoperative septicemia between the ALPPS group and the PVE group (RR=8.56,95%CI=0.24-303.45,P=0.24); (6). There was no significant difference in the incidence of postoperative biliary leakage between the ALPPS group and the PVE group (RR=2.12,95%CI=1.00-4.50,P=0.05); (7). There was no significant difference (RR=0.85,95%CI=0.38-1.89,P=0.69); (8) between the ALPPS group and the PVE group (RR=0.85,95%CI=0.38-1.89,P=0.69); (8). There was a significant difference (MD=-23.45,95%CI=-28.90--18.01,P0.00001); (9) R0 (radical 0, radical) resection rate between the ALPPS group and the PVE group. The death rate of R0 in PVE group was significantly different (RR=2.99,95%CI=1.33-6.75,P=0.008); (10). There was no significant difference in 90 day mortality rate (RR=1.94,95%CI=0.85-4.39,P=0.11) between ALPPS group and PVE group. Conclusion the growth rate of FLR, the growth rate of daily FLR, the rate of completion of two-step hepatectomy, the rate of complete hepatectomy in the ALPPS group and the PVE group were better than those in the PVE group, and the incidence of postoperative complications and postoperative (septicemia, biliary leakage) were higher in the ALPPS group than in the PVE group. There was no significant difference between the two groups in 90 days mortality of liver failure.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7
【相似文献】
相关硕士学位论文 前1条
1 薛丽名;ALPPS与PVE两步肝切除术的Meta分析[D];青海大学;2017年
，本文编号：2261029
本文链接：https://www.wllwen.com/yixuelunwen/zlx/2261029.html
