目的 系统性评价肝静脉剥夺术(LVD)与门静脉栓塞(PVE)治疗剩余肝体积(FLR)不足的肝脏恶性肿瘤的效果及预后.方法 本研究根据PRISMA指南完成,PROSPERO注册号:CRD42024533292.检索PubMed、Embase、Cochrane Library、Web of Science、知网、万方、维普等数据库中关于LVD与PVE效果比较的所有文献.根据制定的纳入和排除文献标准,筛选相关文献,评估文献质量,提取相关LVD与PVE的临床对比资料,整理并分析数据.使用RevMan 5.3软件进行Meta分析.结果 共纳入12篇文献(均为队列研究),含644例患者(LVD组245例,PVE组399例).Meta分析结果显示,在栓塞后FLR增长率(SMD=0.84,95%CI:0.59～1.09)、栓塞后FLR每日增长体积(SMD=1.19,95%CI:0.64～1.73)、栓塞后并发症发病率(RR=1.59,95%CI:1.06～2.38)、栓塞与二期手术间隔时间(SMD=-0.81,95%CI:-1.32～-0.29)和二期手术完成率(RR=1.09,95%CI:1.01～1.18)两组间差异均有统计学意义(P值均<0.05).结论 LVD相较于PVE能够使患者在相对较短的时间内获得达到手术指征的FLR,从而降低疾病进展的发生率以及解决肥大不足的问题,达到更高的二期手术切除率,从而使更多的肝癌患者受益.并且,LVD在二期手术中具有和PVE相似的安全性.
Clinical efficacy of liver venous deprivation versus portal vein embolization in treatment of liver cancer with insufficient residual liver volume:A Meta-analysis
Objective To systematically evaluate the efficacy and prognosis of liver venous deprivation(LVD)versus portal vein embolization(PVE)in the treatment of hepatic malignancies with insufficient residual liver volume.Methods This study was conducted according to PRISMA guidelines,with a PROSPERO registration number of CRD42024533292.Databases including PubMed,Embase,the Cochrane Library,Web of Science,CNKI,Wanfang Data,and VIP were searched for articles on the efficacy of LVD versus PVE.According to the inclusion and exclusion criteria,related articles were screened for quality assessment and extraction of clinical data for LVD and PVE,and related data were summarized and analyzed.RevMan 5.3 was used to perform the Meta-analysis.Results A total of 12 articles(all cohort studies)were included,involving 644 patients(245 in the LVD group and 399 in the PVE group).The Meta-analysis showed that there were significant differences between the two groups in FLR growth rate after embolization(standardized mean difference[SMD]=0.84,95%confidence interval[CI]:0.59-1.09,P<0.05),daily growth volume of FLR after embolization(SMD=1.19,95%CI:0.64-1.73,P<0.05),the incidence rate of complications after embolization(risk ratio[RR]=1.59,95%CI:1.06-2.38,P<0.05),interval between embolization and second-stage surgery(SMD=-0.81,95%CI:-1.32 to-0.29,P<0.05),and the completion rate of second-stage surgery(RR=1.09,95%CI:1.01-1.18,P<0.05).Conclusion Compared with PVE,LVD can enable patients to achieve FLR for surgery in a relatively short period of time,thereby reducing the incidence rate of disease progression,solving the problem of hypertrophic deficiency,achieving a higher second-stage surgical resection rate,and bringing more benefits to patients with liver cancer.In addition,LVD has similar safety profiles to PVE during second-stage surgery.
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