摘要
背景与目的:肝门部胆管癌(HCCA)是临床中常见的胆道恶性肿瘤,其解剖位置特殊,侵袭性强,手术难度极大。近年来,随着腹腔镜技术和微创外科理念的发展,腹腔镜HCCA根治性切除术已在一些大型肝胆胰脾疾病医学中心开展,其较传统开腹HCCA根治性切除术具有一定的优势,但两种手术方式的选择仍存在一定的争议。本研究通过Meta分析的方法比较腹腔镜与开腹HCCA根治性切除术的疗效与安全性,为临床实践提供循证医学参考。方法:检索国内外多个数据库,收集比较腹腔镜与开腹HCCA根治性切除术的临床研究,检索日期为建库至2023年8月31日。根据纳入、排除标准筛选文献,并对纳入研究的文献进行资料提取及质量评估后,采用RevMan 5.3软件进行Meta分析。结果:最终共纳入20篇文献,包含1036例患者,其中457例行腹腔镜HCCA根治性切除术(腹腔镜组),579例行开腹HCCA根治性切除术(开腹组)。Meta分析结果显示,主要结局指标方面,腹腔镜组较开腹组淋巴结清扫数目增加(MD=0.61,95%CI=0.11~1.12,P<0.05)、R0切除率增高(OR=2.47,95%CI=1.47~4.14,P<0.05),但术后总并发症发生率及术后1、2、3年生存率的差异均无统计学意义(均P>0.05);次要结局指标方面,腹腔镜组较开腹组手术时间延长(MD=51.39,95%CI=44.78~57.99,P<0.05)、术中出血量减少(MD=-75.29,95%CI=-92.46~-58.12,P<0.05)、切口长度缩小(MD=-10.25,95%CI=-19.12~-1.38,P<0.05),以及术后住院时间、术后进食时间、术后下床时间均缩短(均P<0.05)。结论:基于目前的证据表明,腹腔镜HCCA根治性切除术是安全有效的,能提高淋巴结清扫数目和R0切除率,且创伤更小。鉴于研究的局限性,上述结论尚需更多高质量研究予以验证。
Background and Aims:Hilar cholangiocarcinoma(HCCA)is a prevalent malignant biliary tumor encountered in clinical practice with a unique anatomical location,high invasiveness,and great surgical difficulty.In recent years,with the development of laparoscopic technology and minimally invasive surgical techniques,laparoscopic radical resection of HCCA has been performed in some large hepatobiliary medical centers.This approach has advantages over traditional open radical resection of HCCA,but there is still some controversy regarding the choice between these surgical methods.This study was conducted to compare the efficacy and safety of laparoscopic versus open radical resection of HCCA through a Meta-analysis,providing evidence-based medical references for clinical practice.Methods:The clinical studies comparing laparoscopic and open radical resection of HCCA were collected by searching multiple domestic and international databases.The search period spanned from the inception of each database to August 31,2023.After screening the literature based on inclusion and exclusion criteria,data extraction,and quality assessment of the included studies,a meta-analysis was performed using RevMan 5.3 software.Results:A total of 20 studies were included,involving 1036 patients,of which 457 underwent laparoscopic radical resection of HCCA(laparoscopic group),and 579 underwent open radical resection of HCCA(open group).The meta-analysis results indicated that,in terms of primary outcomes,the laparoscopic group had a higher number of lymph nodes dissected(MD=0.61,95%CI=0.11-1.12,P<0.05)and a higher R0 resection rate(OR=2.47,95%CI=1.47-4.14,P<0.05),but had no statistically significant differences in the overall postoperative complication rate or the 1-,2-,and 3-year survival rates compared with the open group(all P>0.05).For secondary outcomes,the laparoscopic group had a longer operative time(MD=51.39,95%CI=44.78-57.99,P<0.05),less intraoperative blood loss(MD=-75.29,95%CI=-92.46--58.12,P<0.05),and shorter incision length(MD=-10.25,95%CI=-19.12--1.38,P<0.05),as well as shorter length of postoperative hospital stay,time to postoperative food intake,and time to postoperative ambulation compared with the open group(all P<0.05).Conclusion:The current evidence suggests that laparoscopic radical resection of HCCA is safe and effective,with an increased number of lymph nodes dissected,a higher R0 resection rate,and less trauma.However,due to the limitations of the studies,more high-quality research is needed to validate these conclusions further.
作者
吴建林
王伦镔
余峰
李钊
汪杰
赵敬兵
周国俊
冷政伟
WU Jianlin;WANG Lunbin;YU Feng;LI Zhao;WANG Jie;ZHAO Jingbing;ZHOU Guojun;LENG Zhengwei(Department of Hepatobiliary SurgeryⅡ,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China;Cancer Stem Cell Research Center,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2024年第8期1206-1219,共14页
China Journal of General Surgery
基金
四川省医学科研课题基金资助项目(S20050)。
