腹腔镜与开腹手术治疗肝血管瘤疗效对比的meta分析

发布时间：2018-11-18 18:58

【摘要】：目的:肝血管瘤是临床实践中常见的肝脏良性病变,由于体检率增加和住院病人常规检查使肝血管瘤检出率不断增加。手术治疗是临床医师认可的有效治疗方式,随着技术水平的提高和腔镜下新器械的推出,腹腔镜微创技术逐渐应用于肝血管瘤的治疗,改变了现有的治疗模式,并扩大了肝血管瘤的手术治疗的适应症。但相对于传统开腹手术而言,肝血管瘤的手术效果、安全性及应用的必要性仍存在一定争议。本文从循证医学的角度应用Meta分析的方式进行研究,首先检索目前已发表的关于腹腔镜手术治疗对比开腹手术治疗肝血管瘤的病例对照试验,通过对比术中、术后相关临床资料,探讨腹腔镜微创技术拓展应用于肝血管瘤这一病种的临床特征和可行性,进一步指导临床手术方式的选择。方法:应用Cochrane图书馆、中国知网、维普中文科技期刊数据库、Pub Med、Embase、万方医学网等数据库,时间限制为各数据库建立以来至2017年3月1日。使用数据处理软件Rev Man5.3进行数据分析,制作相关森林图及用于定性评价的漏斗图,并结合临床进行相关统计分析。结果:通过检索,纳入13篇文献资料,共纳入690例患者,开腹手术切除肝血管瘤例数共338例,行腹腔镜手术切除的患者共352例。经过软件meta分析,腹腔镜组在降低术中出血量、减少手术时间、缩短住院所需时间、最大限度减少术后并发症发面优于开腹手术治疗肝血管瘤的病例,两组在切肝时间、住院费用方面比例方面无统计学差异。结论:腹腔镜手术切除可安全应用于肝血管瘤的临床治疗,与目前传统开腹手术切除相比,腹腔镜手术切除肝血管瘤总体疗效优于开腹手术,能显著减少术中出血量、住院时间、术后并发症发生率,手术时间,同时在住院费用及切肝时间方面两种术式相当。就目前病例报道而言,由于存在数量相对少、异质性较大、发表偏移等不足,需要进一步多中心的临床病例研究进一步验证。
[Abstract]:Objective: hepatic hemangioma is a common benign disease of liver in clinical practice. The detection rate of hepatic hemangioma is increasing because of the increase of physical examination rate and routine examination of inpatients. Surgical treatment is an effective treatment approved by clinicians. With the improvement of technical level and the introduction of new instruments under laparoscopy, laparoscopic minimally invasive technique has gradually been applied to the treatment of hepatic hemangioma, which has changed the existing treatment mode. The indication of surgical treatment of hepatic hemangioma was expanded. However, compared with the traditional open surgery, the surgical effect, safety and the necessity of application of hepatic hemangioma are still controversial. In this paper, Meta analysis was used to study the Evidence-based Medicine (EBM). First of all, we searched the published case control trials on laparoscopic surgery and open surgery for hepatic hemangioma. To explore the clinical characteristics and feasibility of laparoscopic minimally invasive technique in the treatment of hepatic hemangioma and to further guide the selection of clinical surgical methods. Methods: the Cochrane Library, China knowledge Network, Weipu Chinese Science and Technology Journal Database, Pub Med,Embase, Wanfang Medical Network and other databases were used. The time limit was from the establishment of each database to March 1, 2017. Data processing software Rev Man5.3 was used for data analysis, and relevant forest maps and funnel charts for qualitative evaluation were made, and related statistical analysis was carried out in combination with clinical practice. Results: a total of 690 patients were included, 338 patients were resected by laparotomy and 352 patients underwent laparoscopic resection. According to the analysis of software meta, the laparoscopic group can reduce the amount of intraoperative bleeding, reduce the operation time, shorten the time needed for hospitalization, and minimize the postoperative complications, which is better than the open operation in the treatment of hepatic hemangioma, and the time of hepatectomy in the two groups is better than that in the laparotomy group. There was no statistical difference in the proportion of hospital expenses. Conclusion: laparoscopic resection can be safely used in the clinical treatment of hepatic hemangioma. Compared with traditional open surgery, laparoscopic resection of hepatic hemangioma is more effective than open surgery, and can significantly reduce the amount of intraoperative bleeding. The length of hospitalization, the incidence of postoperative complications, the time of operation, the cost of hospitalization and the time of liver resection were similar. As far as the current case reports are concerned, due to the relatively small number, large heterogeneity, publication offset and other deficiencies, further multi-center clinical case studies are needed to further verify.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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