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目的:系统性评价精准肝切除治疗原发性肝癌的近期疗效。方法:检索国内外数据库,收集有关比较精准肝切除与常规肝切除治疗原发性肝癌疗效的随机对照试验(RCT)与临床对照试验(CCT)。按纳入标准筛选后进行质量评分,提取数据,采用Rev Man 5.3软件行Meta分析。结果:共纳入了6个RCT及9个CCT,其中患者1 367例,精准肝切除术685例(精准组),传统肝切除术682例(对照组)。Meta分析结果显示,与对照组比较,精准组术中出血量、围手术期输血量、住院时间减少,但手术时间延长(MD=-175.45,95%CI=-234.37~-116.53;MD=-311.04,95%CI=-444.53~-177.55;MD=-3.11,95%CI=-4.36~-1.87;MD=31.72,95%CI=12.00~51.44,均P<0.05);肿瘤完整切除率提高(OR=0.18,95%CI=0.07~0.45,P=0.0003);肝功能恢复加快(ALT:M D=-81.75,95%C I=-109.50~-54.00;AST:M D=-67.27,95%C I=-94.36~-40.18;TBIL:M D=-4.54,95%CI=-7.33~-1.75;ALB:MD=3.75,95%CI=0.54~6.97,均P<0.05);并发症发生率减少(OR=0.24,95%CI=0.17~0.35,P<0.05);1年复发率降低、1年生存率提高(OR=0.56,95%CI=0.37~0.85;OR=1.61,95%CI=1.01~2.57,均P<0.05)。结论:精准肝切除治疗原发性肝癌较常规肝切除创伤小、恢复快,且近期预后好。
Objective: To systematically evaluate the short-term curative effect of precision hepatectomy on primary liver cancer. Methods: We searched domestic and foreign databases and collected randomized controlled trials (RCTs) and controlled trials (CCTs) on the efficacy of more precise hepatectomy and conventional hepatectomy in the treatment of primary liver cancer. According to inclusion criteria, the quality score was screened and the data was extracted. Meta analysis was performed with Rev Man 5.3 software. Results: A total of 6 RCTs and 9 CCTs were enrolled, including 1 367 patients, 685 patients undergoing precision hepatectomy (precision group) and 682 patients undergoing conventional hepatectomy (control group). The results of Meta - analysis showed that the blood loss, perioperative blood transfusion and hospital stay in the precise group decreased but the operation time was longer (MD = -175.45,95% CI -234.37 ~ -116.53; MD = 311.04, 95% CI = -444.53 ~ -177.55, MD = -3.11, 95% CI = -4.36 ~ -1.87, MD = 31.72, 95% CI = 12.00 ~ 51.44, all P < (OR = 0.18, 95% CI = 0.07-0.45, P = 0.0003); accelerated hepatic function recovery (ALT: MD = -81.75,95% CI -109.50 ~ -54.00; AST: MD = -67.27,95% CI = -94.36 ~ -40.18; TBIL: MD = -4.54, 95% CI = -7.33 ~ -1.75; ALB: MD = 3.75, 95% CI = 0.54 ~ 6.97, all P < OR = 0.24, 95% CI = 0.17-0.35, P <0.05); 1-year recurrence rate decreased and 1-year survival rate increased (OR = 0.56,95% CI = 0.37-0.85; OR = 1.61,95% CI = ~ 2.57, all P <0.05). Conclusion: The precision hepatectomy for the treatment of primary liver cancer than conventional hepatectomy trauma, rapid recovery, and the recent good prognosis.