術中聯合淋巴結清掃對肝內膽管細胞癌預后影響的薈萃分析

龐書杰，施洋，楊寧，葉慶旺，楊廣順(東方肝膽外科醫院肝外五科，上海200438)

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術中聯合淋巴結清掃對肝內膽管細胞癌預后影響的薈萃分析

龐書杰，施洋，楊寧，葉慶旺，楊廣順
(東方肝膽外科醫院肝外五科，上海200438)

[摘 要]目的 評價術中聯合淋巴結清掃術能否提高肝內膽管細胞癌預后。方法 計算機檢索2005年1 月1日至2015年3月31日期間PubMed、EmBase、Web of Science、中國知網、維普、萬方數據庫收錄的比較肝內膽管細胞癌根治術中是否聯合淋巴結清掃術對預后影響的文獻，文獻納入由兩名研究者獨立篩選，經過質量評價與數據提取后，采用RevMan5.3進行Meta分析。結果 共納入5篇隊列研究，納入病例總數522例，其中行淋巴結清掃術[LND(+)]272例，未行淋巴結清掃術[LND(-)]250例。Meta分析顯示術后3年總生存(RR=0.91，95%CI:0.74～1.13，P=0.41)，術后5年總生存率(RR=0.84，95%CI:0.63～1.11，P=0.22)，術后3年無瘤生存率(RR=0.89，95%CI:0.65～1.21，P=0.47)。結論 術中常規聯合淋巴結清掃術對肝內膽管細胞癌預后無明顯影響。

[關鍵詞]肝內膽管細胞癌；淋巴結清掃術；預后；Meta分析

The impact of lymphadenectomy on the prognosis of intrahepatic cholangiocarcinoma:a Meta –analysis

PANG Shu-Jie, SHI Yang, YANG Ning, YE Qing-wang, YANG Guang-shun.Department V of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China

Abstract ObjectiveTo evaluate whether lymphadenectomy can improve the postoperative prognosis of patients with intrahepatic cholangiocarcinoma (ICC) or not.MethodsPubMed, EmBase, Web of Science, CNKI, VIP, Wanfang Database were retrieved to collect researches published between 1stJan.2005 to 31stMar.2015.The inclusion and evaluation of those researches were conducted by two researchers independently, and then the data were extracted and analyzed by using RevMan 5.3 version.ResultsA total of 5 cohort studies which involved 522 patients with ICC were included in this study.There was no signi■cant difference between LND(+) and LND(-) group in terms of the 3-year overall survival rate (RR=0.84, 95%CI:0.74～1.13, P=0.41), the 5-year overall survival rate (RR=0.84, 95%CI:0.63～1.11, P=0.22) and the 3-year disease free survival rate (RR=0.89, 95%CI:0.65～1.21, P=0.47).ConclusionRoutine lymphadenectomy can not improve the prognosis of patiens with ICC after curative hepatectomy.

Key words intrahepatic cholangiocarcinoma； lymphadenectomy； prognosis； Meta -analysis

肝內膽管細胞癌(intrahepatic cholangiocarcinoma，ICC)發生于二級膽管以上的肝內末梢膽管，為肝細胞癌之后的第二大常見的原發性肝臟惡性腫瘤，約占原發性肝癌的10%～15%[1-3]。由于肝內膽管細胞癌早期缺乏特異性的臨床癥狀，多數患者確診時已為腫瘤進展期。另外，肝內膽管細胞癌惡性程度高，進展較快，早期就易伴發肝門部淋巴結轉移，根治性手術治療是目前延長患者生存期的有效治療策略之一[1]。但是，ICC根治手術是否需要常規聯合淋巴結清掃術仍存在爭議。本研究通過薈萃分析來評價術中聯合淋巴結清掃能否改善肝內膽管細胞癌手術預后，為臨床上ICC的手術方案選擇提供循證依據。……