结直肠癌肝转移灶首次切除和复发后第二次切除对比的meta分析-meta - analysis of comparison between first resection and second resection after recurrence of liver metastases from colorectal cancer.docx

摘要目 的 比较结直肠癌肝转移灶首次切除和二次切除临床疗效和安全性。方 法 检索国内外 1992.1-2010.6 间发表的所有关于结直肠癌肝转移灶首次切除和二次 切除对比的研究，由 2 名作者各自独立地摘录入选文献数据，包括基本特征、术后并发症 发生率和死亡率；疾病的复发率；远期疗效。文献质量评价采用改良的 Newcastle-Ottawa Score 方法，统计学分析采用 RevMan4.2 软件。结 果 按照筛选标准，共有 22 篇文献 3750 例结直肠癌患者入选。手术持续时间差别有 统计学意义（P0.00001，95%CI=-65.21，-23.13），再次切除手术比首次切除手术时间增 加 39 分钟；术中输血量差别有统计学意义（P0.00001，95%CI=-1.75，-0.79），术中输血 量增加 1.1U.术中失血量，术中输血人数，术后 ICU 住院时间，术后失血及术后住院时间 无显著性差异（P0.05）。术后总并发症发生率及具体并发症发生率、远期疗效 1 年、3 年、5 年生存率、无瘤生存期及复发率均无显著差异（P0.05）。结 论 与结直肠肝转移灶首次切除比较，复发后二次切除具有其相似的手术安全性和 有效性。手术切除为复发后治疗的首选方案，但是为了获得更有效的远期疗效，应进一步 考虑综合治疗。关键词 结直肠癌；肝转移瘤；首次切除；二次切除AbstractObjective To compare clinical outcomes and safety of repeat hepatectomy for patients with liver metastases from colorectal cancer with those of a first liver resection.Methods The literature was searched for all studies reported on repeat hepatectomy versus a first liver resection patients with liver metastases from colorectal cancer between January 1991 to July 2007. Two authors independently extracted data using the following outcomes: postoperative complications and mortality; disease recurrence; and long-term survival. Trials were assessed using the modified Newcastle-Ottawa Score.Date analysis were performed by RevMan 4.2.Results According to the same screening criteria, 22 clinical studies were included in our systematic reviews. Sample volume in this Meta analysis was 3750 liver metastases from colorectal cancer cases. Operation time and intraoperatie blood transfusions are statisticallysignificant differences（P0.05）。In comparision with the first liver resection group, Operationtime of the repeat hepatectomy group was longer by 39 minutes,[95%CI（-65.21，-23.13）, P0.00001], intraoperatie blood transfusions was longer by 1.1 U, [95%CI（-1.75，-0.79）,P0.00001] .There were no significant differences in the number of patient of intraoperatie blood transfusions, number of bleeding patient, length of intensive care unit stay,length of hospitalization (P0.05）. There were no sign