PDF(Pubmed)
Abstract：
UNASSIGNED: Application of hemihepatic inflow occlusion (HIO) and total hepatic inflow occlusion (TIO) are two common approaches for hepatectomy. However, their efficacy and safety remain controversial.
UNASSIGNED: Randomized control trials (RCTs) published before 15t January 2023 were included by a systematic literature search, which compared the clinical outcomes between HIO and TIO. The primary outcome was the estimated blood loss (EBL). Three independent authors screened and extracted the data and resolved disagreements by consensus. The ROB2.0 tool was used for evaluating the risk of bias.
UNASSIGNED: A total of 1026 patients (511 TIO and 515 HIO) from 9 studies were analyzed in the meta-analyses. The EBL between TIO and HIO group was similar, while HIO was associated with a lower proportion of patients required transfusion (P=0.002), less units of blood transferred (P<0.001) and a lower overall complication rate (P=0.008). There were no significant differences between TIO and HIO in mortality (P=0.37), length of stay (P=0.97), bile leak rate (P=0.58), liver failure rate (P=0.96), reoperation rate (P=0.48), postoperative haemorrhage rate (P=0.93) and incidence of postoperative ascites (P=0.96). The operative time of HIO was usually no more than 15 min longer than that of TIO (P<0.001).
UNASSIGNED: Comparing with the TIO, HIO increased the operative time and failed to further reduce the EBL in patients with liver surgery. However, despite the complexity of the operation, HIO was recommended due to the similar effect on the consumption of blood products and the postoperative complications.
UNASSIGNED: Randomized control trials (RCTs) published before 15t January 2023 were included by a systematic literature search, which compared the clinical outcomes between HIO and TIO. The primary outcome was the estimated blood loss (EBL). Three independent authors screened and extracted the data and resolved disagreements by consensus. The ROB2.0 tool was used for evaluating the risk of bias.
UNASSIGNED: A total of 1026 patients (511 TIO and 515 HIO) from 9 studies were analyzed in the meta-analyses. The EBL between TIO and HIO group was similar, while HIO was associated with a lower proportion of patients required transfusion (P=0.002), less units of blood transferred (P<0.001) and a lower overall complication rate (P=0.008). There were no significant differences between TIO and HIO in mortality (P=0.37), length of stay (P=0.97), bile leak rate (P=0.58), liver failure rate (P=0.96), reoperation rate (P=0.48), postoperative haemorrhage rate (P=0.93) and incidence of postoperative ascites (P=0.96). The operative time of HIO was usually no more than 15 min longer than that of TIO (P<0.001).
UNASSIGNED: Comparing with the TIO, HIO increased the operative time and failed to further reduce the EBL in patients with liver surgery. However, despite the complexity of the operation, HIO was recommended due to the similar effect on the consumption of blood products and the postoperative complications.
摘要：
■应用半肝流入闭塞（HIO）和全肝流入闭塞（TIO）是两种常见的肝切除术方法。然而,其疗效和安全性仍存在争议.
■在2023年1月15日之前发表的随机对照试验（RCT）通过系统的文献检索纳入，比较了HIO和TIO的临床结果。主要结果是估计的失血量（EBL）。三位独立作者筛选并提取了数据，并通过共识解决了分歧。ROB2.0工具用于评估偏倚风险。
■在荟萃分析中对9项研究中的1026名患者（511TIO和515HIO）进行了分析。TIO和HIO组的EBL相似，而HIO与需要输血的患者比例较低相关（P=0.002），较少单位的血液转移（P<0.001）和较低的总并发症发生率（P=0.008）。TIO和HIO的死亡率无显著差异(P=0.37),住院时间（P=0.97），胆漏率（P=0.58），肝衰竭发生率（P=0.96），再手术率（P=0.48），术后出血发生率(P=0.93)和术后腹水发生率(P=0.96)。HIO的手术时间通常不超过TIO的15分钟（P<0.001）。
■与TIO相比，HIO增加了手术时间，但未能进一步降低肝脏手术患者的EBL。然而,尽管操作复杂，由于对血液制品的消耗和术后并发症的类似影响，建议使用HIO。
■在2023年1月15日之前发表的随机对照试验（RCT）通过系统的文献检索纳入，比较了HIO和TIO的临床结果。主要结果是估计的失血量（EBL）。三位独立作者筛选并提取了数据，并通过共识解决了分歧。ROB2.0工具用于评估偏倚风险。
■在荟萃分析中对9项研究中的1026名患者（511TIO和515HIO）进行了分析。TIO和HIO组的EBL相似，而HIO与需要输血的患者比例较低相关（P=0.002），较少单位的血液转移（P<0.001）和较低的总并发症发生率（P=0.008）。TIO和HIO的死亡率无显著差异(P=0.37),住院时间（P=0.97），胆漏率（P=0.58），肝衰竭发生率（P=0.96），再手术率（P=0.48），术后出血发生率(P=0.93)和术后腹水发生率(P=0.96)。HIO的手术时间通常不超过TIO的15分钟（P<0.001）。
■与TIO相比，HIO增加了手术时间，但未能进一步降低肝脏手术患者的EBL。然而,尽管操作复杂，由于对血液制品的消耗和术后并发症的类似影响，建议使用HIO。
