【摘要】：目的:評(píng)價(jià)微創(chuàng)肝切除治療肝內(nèi)結(jié)石的安全性和有效性。方法:計(jì)算機(jī)檢索國(guó)內(nèi)外數(shù)據(jù)庫(kù),收集比較微創(chuàng)肝切除與開腹肝切除治療肝內(nèi)結(jié)石的文獻(xiàn),提取有效數(shù)據(jù)后用Stata 12.0軟件進(jìn)行Meta分析。結(jié)果:最終納入24篇相關(guān)文獻(xiàn),共有2 051例患者,其中993例行微創(chuàng)肝切除,1 058例行開腹肝切除。Meta分析結(jié)果顯示,與開腹肝切除比較,微創(chuàng)肝切除術(shù)中出血量減少(SMD=-0.867,95%CI=-1.261~-0.472,P0.001)、輸血率降低(OR=0.475,95%CI=0.330~0.683,P0.001)、術(shù)后并發(fā)癥發(fā)生率降低(OR=0.493,95%CI=0.382~0.638,P0.001)、術(shù)后禁食時(shí)間縮短(SMD=-1.845,95%CI=-2.609~-1.082,P0.001)、術(shù)后住院時(shí)間減少(SMD=-0.983,95%CI=-1.323~-0.643,P0.001)、結(jié)石復(fù)發(fā)率降低(OR=0.513,95%CI=0.322~0.816,P=0.005),而兩種手術(shù)方式的手術(shù)時(shí)間、術(shù)中結(jié)石清除率、最終結(jié)石清除率均無(wú)統(tǒng)計(jì)學(xué)差異(均P0.05)。結(jié)論:微創(chuàng)肝切除治療肝內(nèi)膽管結(jié)石是一種安全有效的手術(shù)方式,且多數(shù)術(shù)中、術(shù)后指標(biāo)優(yōu)于開腹手術(shù),但仍需要更多臨床隨機(jī)對(duì)照試驗(yàn)進(jìn)一步證實(shí)。
[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.
【作者單位】： 三峽大學(xué)人民醫(yī)院普通外科;荊州市中心醫(yī)院手術(shù)室;
【分類號(hào)】：R657.42

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