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目的系统评价腹腔镜与开腹手术治疗肝细胞癌的疗效。方法计算机检索PubMed、中国期刊全文数据库、万方数据库、中国博硕士学位论文数据库及中国重要会议论文数据库2000～2011年发表的有关腹腔镜肝切除术和开腹肝切除术治疗肝细胞癌的相关文献,采用RevMan 5.0进行Meta分析。结果共纳入11项临床对照试验,包括781例患者,其中经腹腔镜手术治疗325例,开腹手术治疗456例。Meta分析结果显示,与开腹手术相比较,腹腔镜肝切除术能明显缩短手术时间〔加权均数差值(WMD)=-20.85,95%CI(-29.54,-12.16),P<0.000 01〕,减少术中出血量〔标准化均数差值(SMD)=-0.42,95%CI(-0.65,-0.19),P=0.000 4〕,降低术后并发症发生率〔优势比(OR)=0.43,95%CI(0.28,0.65),P<0.000 1〕,缩短住院时间〔WMD=-4.32,95%CI(-6.29,-2.34),P<0.000 1〕。但术后复发率(P=0.80)和术后1年总生存率(P=0.98)、3年总生存率(P=0.41)、5年总生存率(P=0.12)以及1年无瘤生存率(P=0.15)、3年无瘤生存率(P=0.62)和5年无瘤生存率(P=0.99)差异均无统计学意义。结论对于病变位于CouinaudⅡ、Ⅲ、Ⅳ、Ⅴ及Ⅵ段,其直径小于5 cm,并且不影响第一和第二肝门血管的暴露,肝功能在Child B级以上的肝细胞癌患者,在条件允许的情况下可优先考虑腹腔镜肝切除术。
Objective To evaluate the efficacy of laparoscopy and laparotomy in the treatment of hepatocellular carcinoma. Methods The correlation between laparoscopic hepatectomy and open hepatectomy for hepatocellular carcinoma was searched from PubMed, China Journal Full-text Database, Wanfang Database, China Dissertation Database and China Critical Conference Papers Database from 2000 to 2011. Literature, Meta-analysis using RevMan 5.0. Results A total of 11 controlled trials were included, including 781 patients, of whom 325 were treated by laparoscopy and 456 by laparotomy. Meta-analysis showed that laparoscopic hepatectomy significantly shortened the operative time compared with open surgery (WMD = -20.85,95% CI -29.54, -12.16), P <0.000 01 (OR = 0.42, 95% CI (-0.65, -0.19, P = 0.0004)), and the incidence of postoperative complications (OR) = 0.43, 95% CI (0.28, 0.65), p <0.0001], and shorter hospital stay (WMD = -4.32, 95% CI, -6.29, -2.34, P <0.0001). However, postoperative recurrence (P = 0.80), postoperative 1 year overall survival (P = 0.98), 3 year overall survival (P = 0.41), 5 year overall survival (P = 0.12) There was no significant difference in survival rate (P = 0.15), 3-year disease-free survival rate (P = 0.62) and 5-year disease-free survival rate (P = 0.99) CONCLUSIONS: Patients with hepatocellular carcinoma whose liver function is above Child Class B have a diameter of less than 5 cm and are not affected by the presence of lesions in the Couinaud II, III, IV, V and VI, Laparoscopic liver resection may be preferred if this is warranted.