ALPPS與PVE兩步肝切除術(shù)的Meta分析
發(fā)布時間：2018-10-10 06:44
【摘要】：目的:系統(tǒng)的對比評價ALPPS與PVE在部分肝臟切除手術(shù)的療效性和安全性的薈萃分析;為中晚期肝臟剩余體積不足的腫瘤患者選擇手術(shù)方式提供理論依據(jù)。方法:檢索Pubmed、Medline、Cochrane library、Embase、WOS-SCI、CMB、CNKI、VIP各數(shù)據(jù)庫,收集關(guān)于ALPPS與PVE的臨床對照研究,檢索時間均為建庫至2017年01月,依據(jù)納入標(biāo)準(zhǔn)以及排除標(biāo)準(zhǔn)對檢索到的文獻(xiàn)篩選,篩選后的提取相關(guān)數(shù)據(jù),同時進(jìn)行評價質(zhì)量,使用Review Manager 5.3軟件對數(shù)據(jù)進(jìn)行分析。結(jié)果:最終納入7篇文獻(xiàn)研究,總共525例患者,其中ALPPS組126例,PVE組399例�？偡治龊蠼Y(jié)果如下:(1)FLR(future liver remnant,殘余肝體積)增生率,ALPPS組與PVE組有的統(tǒng)計學(xué)差異(MD=10.06,95%CI=7.60-13.61,P0.00001);(2)FLR每日增長速度,ALPPS組與PVE組術(shù)后FLR每日增長速度有顯著的統(tǒng)計學(xué)差異(MD=31.54,95%CI=29.14-33.99,P0.00001);(3)兩步肝切除手術(shù)完成率,ALPPS組與PVE組兩步肝切除手術(shù)完成率有統(tǒng)計學(xué)差異(RR=9.34,95%CI=2.54-34.37,P=0.0008);(4)術(shù)后總并發(fā)癥,ALPPS組與PVE組無統(tǒng)計學(xué)差異(RR=1.37,95%CI=0.93-2.03,P=0.12);(5)術(shù)后敗血癥,ALPPS組與PVE組術(shù)后敗血癥發(fā)生率無統(tǒng)計學(xué)差異(RR=8.56,95%CI=0.24-303.45,P=0.24);(6)術(shù)后膽漏,ALPPS組與PVE組術(shù)后膽漏發(fā)生率的無統(tǒng)計學(xué)差異(RR=2.12,95%CI=1.00-4.50,P=0.05);(7)術(shù)后肝功能衰竭,ALPPS組與PVE組無統(tǒng)計學(xué)差異(RR=0.85,95%CI=0.38-1.89,P=0.69);(8)住院日,ALPPS組與PVE組住院日有統(tǒng)計學(xué)差異(MD=-23.45,95%CI=-28.90--18.01,P0.00001);(9)R0(radical 0,根治性)切除率,ALPPS組與PVE組R0切除率有統(tǒng)計學(xué)差異(RR=2.99,95%CI=1.33-6.75,P=0.008);(10)90天死亡率,ALPPS組與PVE組90天死亡率無統(tǒng)計學(xué)差異(RR=1.94,95%CI=0.85-4.39,P=0.11)。結(jié)論:ALPPS手術(shù)組與PVE組在FLR增長率、每日FLR增長速度、兩步肝切除手術(shù)完成率、住院日、R0切除中ALPPS組優(yōu)于PVE組;在術(shù)后總并發(fā)癥發(fā)生率以及術(shù)后(敗血癥、膽漏、肝功能衰竭、90天死亡率)中兩者無明顯統(tǒng)計學(xué)差異。
[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.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.7
本文編號：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.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.7
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1 薛麗名;ALPPS與PVE兩步肝切除術(shù)的Meta分析[D];青海大學(xué);2017年
，本文編號：2261029
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