中国实用外科杂志

中国实用外科杂志

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门静脉结扎与栓塞在肝切除术中应用的Meta分析

宋    伟，邹书兵   

  1. 南昌大学第二附属医院肝胆外科，江西南昌330000
  • 出版日期:2016-03-01 发布日期:2016-03-01

  • Online:2016-03-01 Published:2016-03-01

摘要：

目的    系统评价门静脉结扎（PVL）和门静脉栓塞（PVE）后肝切除前剩余肝体积（FLR）增长率和其他围手术期结局指标。方法    检索相关数据库，收集关于PVL与PVE在肝切除术中应用的随机对照试验（RCT）或临床对照试验（CCT），提取相关数据后，采用RevMan5.3软件进行Meta分析。结果    最终纳入8项研究，共438例病人。Meta分析结果显示：PVE组与PVL组FLR增长率、术后病死率、肝功能衰竭和并发症等方面差异无统计学意义。然而，联合肝脏分隔和门静脉结扎的二步肝切除术（ALPPS）较PVE能明显增加FLR。结论    PVL与PVE在肝切除术中有着相似的FLR增长率、术后病死率和并发症。ALPPS 相比PVE能明显加速FLR增长。

关键词: 肝切除术, 门静脉结扎, 门静脉栓塞, 剩余肝体积, Meta分析

Abstract:

Portal vein ligation versus portal vein embolization for hepatectomy：A Meta-analysis        SONG Wei，ZOU Shu-bing. Department of Hepatobiliary Surgery，the Second Affiliated Hospital of Nanchang University，Nanchang 330000，China
Corresponding author：ZOU Shu-bing，E-mail：zousb999@163.com
Abstract    Objective    To systematically review the growth rate in future liver remnant (FLR) and perioperative outcomes after portal vein ligation (PVL) and portal vein embolization (PVE) before hepatectomy. Methods    Such databases as MEDLINE, EMBASE, PubMed, Cochrane Library, CNKI, VIP, WanFang Data were electronically searched for randomized controlled trials (RCTs) or clinical controlled trials (CCTs) on application of portal vein ligation versus portal vein embolization for staged hepatectomy. The meta-analysis was performed using RevMan 5.3 software. Results A total of 8 studies were included with a total of 438 patients. The results of meta-analysis showed that：There was no difference in the increasement in FLR between PVE group versus PVL group（RR=6.04，95%CI：-0.23—12.32，P> 0.05). Similarly，there was no difference in the interval time，complications after PVE/PVL， progression diseased after PVE/PVL，mortality，postoperative liver failure，morbidity and resectability in the two groups after hepatectomy. However，in a subset analysis comparing FLR with PVE and PVL，there was a significant increasement  in FLR in favor of ALPPS（RR=30.14，95%CI：4.84—55.44，P< 0.05). Conclusion    PVL and PVE for staged hepatectomy have a similar growth rate in FLR，mortality and morbidity rates in the hepatectomy. The ALPPS procedure results in an improved growth rate in FLR compared with PVE.

Key words: hepatectomy, portal vein ligation（PVL）, portal vein embolization（PVE）, future liver remnant（FLR）, Meta-analysis