| Ming Yang,Yanhong Zhang,Miaohang Cui,Jianhua Chen,JinLong Liu. The Value of Partial Hepatectomy in Hilar Cholangiocarcinoma Treatment—Meta Analysis. Oncol Transl Med, 2019, 5: 268-277. |
| Meta分析：肝部分切除术对肝门部胆管癌患者的预后影响 |
| The Value of Partial Hepatectomy in Hilar Cholangiocarcinoma Treatment—Meta Analysis |
| Received:November 10, 2019 Revised:December 24, 2019 |
| DOI：10.1007/s10330-019-0390-0 |
| 中文关键词: 关键词：肝门胆管癌；肝部分切除术；预后分析；meta分析 |
| 英文关键词: Hilar;cholangiocarcinoma, Partial;Hepatectomy, Prognosis, Meta;analysis |
| 基金项目:2018年承德市科学技术研究与发展项目 |
| Author Name | Affiliation | E-mail | | Ming Yang* | Department of General Surgery ,The Affiliated Hospital of Chengde Medical College,Chengde City,Hebei Province,China | 263805652@qq.com | | Yanhong Zhang | Department of General Surgery ,The Affiliated Hospital of Chengde Medical College,Chengde City,Hebei Province,China | | | Miaohang Cui | Department of General Surgery ,The Affiliated Hospital of Chengde Medical College,Chengde City,Hebei Province,China | | | Jianhua Chen | Department of General Surgery,KuanCheng County Traditional Chinese Medicine Hospital,Chengde City,Hebei Province,China | | | JinLong Liu | Department of General Surgery ,The Affiliated Hospital of Chengde Medical College,Chengde City,Hebei Province,China | |
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| 中文摘要: |
| 摘要：
目的：系统评价肝部分切除术在肝门胆管癌患者治疗中的应用价值及预后分析。
方法：计算机检索PubMed，MEDLINE数据库，EMBASE，Cochrane图书馆中。搜集有关肝部分切除术应用在肝门胆管癌患者治疗的临床试验，检索年限为1990年1月1日至2019年5月12日之间的相关文献，由2名研究者独立筛选文献、提取资料及评价纳入研究的风险偏倚后，进行meta分析。提取数据包括患者术后根治情况，生存状况，术后并发症和死亡率。
结果：本研究共纳入22篇符合标准的文献，分为4组，分别为：肝部分切除术后根治组（19篇），肝部分切除术后生存组（16篇），肝部分切除术后发生并发症组（9篇）和肝部分切除术后死亡组（17篇）。结果提示联合肝部分切除术后达到根治性切除率（OR 0.32,95％CI 0.20-0.51）及术后远期生存情况（HR 0.67,95％CI 0.58-0.79）均明显高于肝门胆管癌行单纯胆管切除术组。联合肝部分切除术组患者的并发症发生率（OR 1.99，95％CI 1.37-2.90）和术后死亡率（OR 2.71，95％CI 1.47-4.98）均高于肝门胆管癌单纯胆管切除术组。由于肝切除术根治组异质性较高（I2 = 68.3％，p = 0.000），进行亚组分析后结果显示为：肝门部胆管癌未累及次级胆管分支，单纯胆管切除术同肝部分切除术一样，可以达到同样根治水平（OR 0.94，95％CI 0.54-1.65）。
结论：联合肝部分切除术的应用可以增加肝门胆管癌完成根治性切除术的机会，延长患者术后生存时间。但联合肝部分切除术后的患者的并发症发生率及死亡率均高于行单纯胆管切除术的患者。因此，单纯胆管切除术对部分肝门胆管癌仍然具有一定的临床价值，尤其是Bismuth-Corlette I型 和 II 型的肝门胆管癌患者。 |
| 英文摘要: |
| Abstract
Purpose：To discuss the value of partial hepatectomy to patients with hilar cholangiocarcinoma．
Method：English literatures related to hilar cholangiocarcinoma from January 1，1990 to May 12, 2019 were searched in PubMed, MEDLINE database, EMBASE, Cochrane Library. Postoperative radical cure information，survival condition，morbidity and mortality after operation of the patients were extracted from papers that are satisfied the inclusion criteria for Meta analysis．
Result：Twenty-two papers satisfied the inclusion criteria belonged to 4 study groups．After combining the papers in hepatectomy radical cure group(19 papers)，hepatectomy survival group(16 papers)，hepatectomy morbidity group(9 papers) and hepatectomy mortality group(17 papers)，we found that the rate of radical cure after partial hepatectomy (OR 0.32,95%CI 0.20-0.51) and the survival condition(HR 0.67,95%CI 0.58-0.79) were obviously higher than simple bile duct resection group, while morbidity (OR 1.99，95%CI 1.37-2.90) and mortality(OR 2.71，95%CI 1.47-4.98) of the patients in partial hepatectomy group was higher than simple bile duct resection group．Since there''s significant heterogeneity among papers in hepatectomy radical cure group (I2=68.3%，p=0.000)，sub-group analysis was conducted and the result revealed if the branches of secondary bile ducts wasn’t involved by hilar cholangiocarcinoma，simple bile duct resection could have the same radical cure effect as combined with partial hepatectomy(OR 0.94，95%CI 0.54-1.65).
Conclusion：Partial hepatectomy can increase the radical cure opportunity for patients with hilar cholangiocarcinoma，and extend the survival time after operation, but the morbidity and mortality after operation are higher than simple bile duct resection．Simple bile duct resection still has its value for hilar cholangiocarcinoma of Bismuth-Corlette Type I and II．
Keywords: Hilar cholangiocarcinoma, Partial Hepatectomy, Prognosis, Meta analysis |
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