A meta-analysis study of laparoscopic versus open splenectomy with or without esophagogastric devascularization in the management of liver cirrhosis and portal hypertension.
A meta-analysis study of laparoscopic versus open splenectomy with or without esophagogastric devascularization in the management of liver cirrhosis and portal hypertension.
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DOI：
10.1089/lap.2014.0506
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发表时间：
2015-02
期刊：
影响因子：
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通讯作者：
Xin Zheng;Changwei Dou;Yingmin Yao;Qingguang Liu
中科院分区：
文献类型：
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作者：
Xin Zheng;Changwei Dou;Yingmin Yao;Qingguang Liu
前言：这项荟萃分析的目的是确定腹腔镜脾切除术(LS)和LS加食道胃血管离断术(LSED)是否是治疗门脉高压症的微创替代方案。材料和方法对临床对照试验进行荟萃分析，以评估上述问题。检索了PubMed、Science Direct和SpringerLink数据库。结果共纳入8个已发表的对照试验中的725例肝硬变和/或门静脉高压症患者。腹腔镜组手术时间明显长于开腹组[加权平均差(WMD)35.24(16.74，53.74)；P<；0.01]。然而，腹腔镜组的术中出血量较少[WMD-194.84(-321.34，-68.34)；P=0.003]，术后住院时间较短[WMD4.33(-5.3，-3.36)；P<；.001]。两组并发症发生率相似。在LS和开放脾切除术的亚组研究中，在手术时间、术中出血量和并发症发生率方面没有发现显著差异。LS组术后住院时间明显减少[WMD-4.07(-4.93，-3.21)；P<；.001]。虽然LSED手术时间较长[WMD43·23(17·13，69·32)；P=0·001]，但术中出血量较少[WMD-189.26(-295.71，-82·81；P&t；001)]，术后住院时间较短[WMD-5·41(-7·84，-2·98)；P<；001]。就并发症发生率而言，Meta分析并不支持LSED或开腹脾切除加食管胃血管离断术。结论这一荟萃分析的结果有利于LS和LSED作为一种安全、微创的替代方案治疗肝硬变和门脉高压症。
INTRODUCTION The aim of this meta-analysis was to determine whether laparoscopic splenectomy (LS) and LS with esophagogastric devascularization (LSED) were the minimally invasive alternative for portal hypertension. MATERIALS AND METHODS A meta-analysis of comparative clinical trials was performed to assess our questions noted above. The databases PubMed, ScienceDirect, and Springerlink were searched. RESULTS In total, 725 patients with liver cirrhosis and/or portal hypertension from eight published comparative trials were included. The operation time in the laparoscopic group was more than that in the open group [weighted mean difference (WMD) 35.24 (16.74, 53.74); P<.001]. However, there were less intraoperative blood loss [WMD -194.84 (-321.34, -68.34); P=.003] and a shorter postoperative hospital stay [WMD -4.33 (-5.30, -3.36); P<.001] in the laparoscopic group. The incidence of complications was similar in the two groups. In the subgroup studies about LS versus open splenectomy, no significant differences were found in operation time, intraoperative blood loss, and complication rates. The postoperative hospital stay in the LS group was apparently decreased [WMD -4.07 (-4.93, -3.21); P<.001]. Although the operation time of LSED was longer [WMD 43.23 (17.13, 69.32); P=.001], LSED was associated with less intraoperative blood loss [WMD -189.26 (-295.71, -82.81); P<.001] and a shorter postoperative hospital stay [WMD -5.41 (-7.84, -2.98); P<.001]. Meta-analysis did not favor either LSED or open splenectomy with esophagogastric devascularization in term of complication rates. CONCLUSIONS The results of this meta-analysis were in favor of LS and LSED for being a safe, minimally invasion alternative for patients with liver cirrhosis and portal hypertension.