【作者】 王伟；

【导师】 丁伟；

【作者基本信息】 新疆医科大学 ， 外科学（专业学位）， 2015， 硕士

【摘要】 目的：系统评价原发性肝癌患者采取精准肝切除与常规肝切除术两种不同的手术方式对疗效及安全性的影响。方法：计算机检索Pubmed、中国生物医学数据库、CNKI及万方数据库关于精准肝切除与常规肝切除治疗原发性肝癌的随机对照试验(RCT)及临床对照试验(CCT)。运用RevMan 5.3软件对精准肝切除与常规肝切除在术中、术后及预后疗效指标进行Meta分析。结果：共纳入4个随机对照试验和5个临床对照试验,共774例患者.精准肝切除与常规肝切除相比,显著缩短了住院时间[MD=-3.22,95%CI:-3.93--2.51,P<0.00001],减少了术中出血量[MD==-228.61, 95%CI:-308.46--148.76,P<0.00001],明显降低了切缘残存率[OR=0.12,95%CI: 0.04-0.35,P<0.0001],降低了1年复发率[OR:0.50,95%CI:0.32-0.78,P=0.003],提高了1年生存率[OR=2.16,95%CI:1.34-3.46,P=0.001],加快了术后谷丙转氨酶恢复[MD=-122.00,95%CI:-195.05-48.95,P=0.001]与谷草转氨酶恢复[MD=-160.79, 95%CI:-224.81--96.77),P<0.00001],及总胆红素恢复[MD=-8.74,95%CI:-10.57--6.91),P<0.00001],而术后白蛋白恢复无显著差别(P=0.22)。显著减少了总并发症发生率[OR=0.29,95%CI:0.19-0.45,P<0.00001],其中胸腹腔积液发生率明显减少[OR=0.41,95%CI:0.22-0.75,P=0.004],胆漏发生率降低[OR=0.32,95%CI:0.12-0.86, P=0.02],而肝衰竭、感染及消化道出血发生率差异无统计学差异(P>0.05)。结论：现有的研究表明,精准肝切除对于原发性肝癌的治疗较常规肝切除具有良好临床的效果,不仅能够彻底清除病灶,而且降低了复发率,提高了患者生存率,加快术后肝功能恢复,减少术后并发症,具有创伤小、恢复快、安全有效等优点,但是由于试验样本数量偏少,期待更多高质量试验的证据。更多还原

【Abstract】 Objective:To evaluate the Precise system for the treatment of Primary liver resection liver cancer clinical results. Method:Pub Med, CNKI Chinese Biomedical Database(CBM), and Wanfang databases were searched to identify randomized controlled trialsnd controlled trials that assessed the efficacy of Precise keratectomy and Conventional hePatectomy in treatment of Primary liver cancer。Using RevMan 5.3 software for Precise liver resection and conventional liver resection in the Postoperative Prognosis of outcome measures and Meta-analysis Results. Result:A total of four randomized controlled trials and five controlled clinical trials, A total of 774 cases of Patients. Compared to Precise liver resection and conventional liver resection, Significantly shorten the hospital stay [MD=-3.22,95% CI:-3.93-2.51, P<0.00001], Reduces blood loss [MD=-228.61,95%CI:-308.46-148.76, P<0.00001],Significantly reduces the residual ratio of margin [OR=0.12,95% CI:0.04-0.35, P<0.0001],Reducing the 1-year recurrence rate, Improved one-year survival rate [OR=2.16,95% CI:1.34-3.46, P=0.001],Almandine aminotransferase accelerated Postoperative recovery [MD=-122.00,95% CI:-195.05-48.95, P=0.001] and aspartame aminotransferase recovery [MD=-160.79,95% CI:-224.81--96.77), P<0.00001],And total bilirubin recovery [MD =-8.74,95% CI:-10.57--6.91), P<0.00001],The Postoperative recovery of albumin was no significant difference (P=0.22).Significantly reducing the overall incidence of complications, The incidence of abdominal effusion which significantly reduced, Reduced incidence of bile leakage [OR=0.32,95% CI:0.12-0.86, P=0.02],And liver failure, infection and the incidence of gastrointestinal bleeding was no significant difference (P> 0.05).Conclusions:Existing studies show, Precise liver resection for the treatment of Primary liver cancer compared with conventional liver resection with good clinical results, Not only able to completely remove the lesion, And reduces the recurrence rate and improve the survival rate, accelerate Postoperative recovery of liver function, reduce Postoperative complications, With less trauma, quicker recovery, safe, effective, etc., However, due to the small simple size, expect more high-quality trials Provide evidence.更多还原