中国实用外科杂志

中国实用外科杂志

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肝切除术中第一肝门阻断和选择性肝血流阻断疗效Meta分析

蒋    恒1，钱叶本2   

  1. 1安徽医科大学第二附属医院普外科，安徽合肥230601；2安徽医科大学第一附属医院外三病区，安徽合肥230032
  • 发布日期:2012-10-19

  • Published:2012-10-19

摘要：

目的    对第一肝门阻断和选择性肝血流阻断（SHVE）在肝切除术的疗效进行综合比较及Meta分析。方法    对1996年5月至2011年7月通过Medline、Elsevier、中国期刊全文数据库、万方数据检索、Pubmed发表的有关肝切除术中采用第一肝门阻断和SHVE进行肝血流阻断的相关随机对照研究（RCT）文献，采用Cochrance协作网提供的ReMan 5.1软件用固定效应模型进行Meta分析。 结果    按照入选标准，有9项临床试验纳入。Meta结果显示：SHVE组术中出血量较第一肝门阻断组少131.29 mL（P<0.001）；手术时间SHVE组较第一肝门阻断组延长12.66 min；住院时间SHVE组较第一肝门阻断组少2.68 d（P<0.001）；SHVE组术后肝功能衰竭发生率以及其他并发症（包括大量腹水、胸腔积液、肺部感染等）发生率较第一肝门阻断组明显降低（P<0.05）；胆漏发生率两组差异无统计学意义（P>0.05）。 结论    肝脏手术中采用选择性肝血流阻断安全可靠，相比传统第一肝门阻断减少了术中出血、缩短术后住院时间，降低了肝功能衰竭等并发症发生率。

关键词: 肝切除, 肝血流阻断, Meta分析

Abstract:

Comparison between effects of selective hepatic vascular exclusion versus pringle maneuver in liver resections: a Meta-analysis        JIANG Heng*, QIAN Ye-ben. *The Second Hospital of Anhui Medical University, Hefei 230601, China
Corresponding author: QIAN Ye-ben, E-mail: qianyeben@hotmail.com
Abstract    Objective    To compare the clinical effects of selective hepatic vascular exclusion (SHVE) versus pringle maneuver (Pringle) in liver resections. Methods    Randomized controlled trial (RCT) reports on SHVE and Pringle in liver resections from May 1996 to July 2011 were collected from Medline, Elsevier, China National Knowledge Infrastructure (CNKI) ,  Wanfang databases and Pubmed. RevMan 5.1 software was used for data analysis. Results According to the included criteria, 9 clinical trials were selected finally. Blood loss of SHVE group was lower by 131.29mL than that of Pingle group (P<0.001). Operation time of SHVE was longer by 12.66 minutes than Pringle (P<0.05). Hospital stay of Pringle group was longer by 2.68 days than that of SHVE group (P<0.001). Hepatic failure and other complications（massive ascites，pleural effusion，lung infection and so on ）of SHVE were lower than those of Pringle (P<0.05). No significant difference was noted in bile leakage between 2 groups (P>0.05). Conclusion    SHVE is safe and feasible in liver resections. It helps more to reduce blood loss, hospital stay and incidence of live failure than the pringle maneuver.

Key words: hepatectomy, hepatic vascular exclusion, Meta-analysis