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已发表论文
对肝癌并发脾功能亢进同时施行肝切除术和脾切除术与单纯进行肝切除术的对比: 一项综合分析
Authors Li W, Shen SQ, Wu SM, Chen ZB, Hu C, Yan RC
Received 29 April 2015
Accepted for publication 14 July 2015
Published 19 August 2015 Volume 2015:8 Pages 2129—2137
DOI http://dx.doi.org/10.2147/OTT.S87580
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Manfred Beleut
Peer reviewer comments 4
Editor who approved publication: Professor Daniele Santini
Background: This study systematically compared the efficacy and safety of simultaneous hepatectomy and splenectomy (HS) with hepatectomy (H) alone in patients with hepatocellular carcinoma (HCC) and hypersplenism.
Methods: The PubMed, Web of Science, Science Direct, EMBASE, and Cochrane Library databases were systematically searched by two independent researchers through to March 31, 2015 to identify relevant studies. All the extracted literature were managed by Bibliographic citation management software. Quality assessment of the included studies was performed using a modified Newcastle–Ottawa Scale judgment. The data were analyzed using RevMan5.2 software.
Results: Eight studies including a total of 761 patients with HCC and hypersplenism (360 in the HS group, 401 in the H group) were finally included in the analysis. Outcomes, including postoperative complications, perioperative mortality, operation time, 5-year survival rate, and need for blood transfusion did not differ significantly between the two groups. HS was associated with significantly more intraoperative bleeding (mean difference [MD] 57.15, 95% confidence interval [CI] 18.83–95.46, P =0.003), and CD4/CD8 ratio (MD 0.69, 95% CI 0.61–0.77, P <0.00001), CD4 subset, platelet count (MD 213.06, 95% CI 202.59–223.53, P <0.0001), white blood cell count (MD 4.85, 95% CI 4.58–5.13, P <0.0001), interferon-gamma levels (MD 18.52, 95% CI 13.93–23.11, P <0.00001), and interleukin-2 levels (MD 20.73, 95% CI 16.05–25.41, P <0.0001). In addition, lower CD8 subset (MD −7.85, 95% CI −9.07, −6.63, P <0.00001) and interleukin-10 levels (MD −18.56, 95% CI −22.61, −14.50, P <0.00001) were observed for HS.
Conclusion: We identified that simultaneous HS do not increase postoperative complications, operation time, or perioperative mortality in patients with HCC and hypersplenism. Simultaneous splenectomy can increase postoperative white blood cell and platelet counts significantly, improve blood coagulation, reduce the incidence of postoperative bleeding, and enhance immunity. Therefore, HS is safe, effective, and feasible for patients with HCC and hypersplenism.
Keywords: hepatocellular carcinoma, hypersplenism, simultaneous hepatectomy and splenectomy, hepatectomy, meta-analysis
Methods: The PubMed, Web of Science, Science Direct, EMBASE, and Cochrane Library databases were systematically searched by two independent researchers through to March 31, 2015 to identify relevant studies. All the extracted literature were managed by Bibliographic citation management software. Quality assessment of the included studies was performed using a modified Newcastle–Ottawa Scale judgment. The data were analyzed using RevMan5.2 software.
Results: Eight studies including a total of 761 patients with HCC and hypersplenism (360 in the HS group, 401 in the H group) were finally included in the analysis. Outcomes, including postoperative complications, perioperative mortality, operation time, 5-year survival rate, and need for blood transfusion did not differ significantly between the two groups. HS was associated with significantly more intraoperative bleeding (mean difference [MD] 57.15, 95% confidence interval [CI] 18.83–95.46, P =0.003), and CD4/CD8 ratio (MD 0.69, 95% CI 0.61–0.77, P <0.00001), CD4 subset, platelet count (MD 213.06, 95% CI 202.59–223.53, P <0.0001), white blood cell count (MD 4.85, 95% CI 4.58–5.13, P <0.0001), interferon-gamma levels (MD 18.52, 95% CI 13.93–23.11, P <0.00001), and interleukin-2 levels (MD 20.73, 95% CI 16.05–25.41, P <0.0001). In addition, lower CD8 subset (MD −7.85, 95% CI −9.07, −6.63, P <0.00001) and interleukin-10 levels (MD −18.56, 95% CI −22.61, −14.50, P <0.00001) were observed for HS.
Conclusion: We identified that simultaneous HS do not increase postoperative complications, operation time, or perioperative mortality in patients with HCC and hypersplenism. Simultaneous splenectomy can increase postoperative white blood cell and platelet counts significantly, improve blood coagulation, reduce the incidence of postoperative bleeding, and enhance immunity. Therefore, HS is safe, effective, and feasible for patients with HCC and hypersplenism.
Keywords: hepatocellular carcinoma, hypersplenism, simultaneous hepatectomy and splenectomy, hepatectomy, meta-analysis
