RESUMO
Objective To systematically evaluate the clinical efficacy of immunonutrition support in perioperative period of hepatectomy.Methods Literatures were researched using CNKI,CBM,Wanfang database,VIP databases,PubMed (Medline),Embase,Web of science,Science Direct,Cochrane Center from January 1996 to March 2018 with the key words including " 肝切除术,免疫营养,hepatectomy,hepatic resection,immunonutrition,immunoenhanced nutrition".The randomized controlled trials (RCTs) on comparison of efficacy of immunonutrition support versus routine nutritional support in perioperative period of hepatectomy.Patients in the immunonutrition group received immunonutrition support in perioperative period of hepatectomy,and patients in the routine nutrition group received routine nutritional support in perioperative period of hepatectomy.Outcome measures:overall incidence of postoperative complications,incidence of postoperative infectious complications,incidence of postoperative liver failure,perioperative mortality,hospital stay,and hospitalization expenses.Literatures screening,data extraction and quality assessment of methodology were conducted by two researchers separately.Count data were represented as risk ratio (RR) and 95％ confidence interval (CI).Measurement data were represented as mean difference (MD) or weighted mean difference (WMD) and 95％CL Heterogeneity of the included studies was analyzed with I2.Funnel plot was used to test potential publication bias if the number of studies included ≥ 10,and funnel plot was used to test potential publication bias for the outcome measures with the maximum number of studies if the number of studies included ＜ 10.Results (1) Document retrival:12 RCTs were enrolled in the Meta analysis,and the total sample size was 1 136 patients,including 568 patients in the immunonutrition group and in the routine nutrition group,respectively.(2) Results of Meta-analysis:the that immunonutrition group had lower overall incidence of postoperative complications,incidence of postoperative infectious complications,incidence of postoperative liver failure,and hospital stay (RR =0.57,0.49,0.30,MD=-3.28,95％CI:0.46-0.71,0.37-0.65,0.12-0.74,-4.45 to-2.11,P＜0.05),and higher hospital expenses (MD =11.86,95％CI:10.96-12.77,P＜0.05) compared with the routine nutrition group.There was no significant difference in the perioperative mortality between the two groups (RR=0.26,95％ CI:0.07-1.05,P＞0.05).The bilateral symmetry was presented in the funnel plot based on the 9 studies comparing incidence of postoperative infectious complications between the immunonutrition group and routine nutrition group,suggesting that publication bias had little influence on results of Meta-analysis.Conclusions Perioperative immunonutrition support for hepatectomy is safe and feasible.Compared with routine nutritional support,immunonutrition support can significantly reduce overall incidence of postoperative complications,incidence of postoperative infectious complications,incidence of postoperative liver failure,and shorten the hospital stay without increasing postoperative mortality.
RESUMO
Objective To exlore and analyze the curative effect and pognostic factors of surgical treatment for hilar cholangiocarcinoma.Methods The clinical data and prognosis of 92 patients with hilar cholangiocarcinoma admitted to Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2010 to January 2018 were retrospectively analyzed.There were 58 males and 34 females,with an age range of 35-81 years and average age of 61.3 years.Among them,50 patients underwent radical resection of tumors (radical operation group),and 42 patients were discussed to undergo radical operation before operation,but only palliative resection of tumors or simple biliary drainage (palliative operation group) were performed because of the high location of tumors or distant metastasis during operation.Of the 50 patients who received radical surgery,27 underwent simple perihepatic portectomy (perihepatic hilar resection group),and 23 underwent combined hepatic lobectomy (extended hepatectomy group).The incidence of perioperative complications,perioperative mortality and long-term survival rate of all patients were collected.The data of clinical cases included in the study were analyzed by univariate and multivariate analysis,and the relationship between perioperative mortality and prognosis survival time was discussed.The measurement data that accord with normal distribution were expressed by (Mean ± SD).The comparison between the two groups was performed by t-test,the comparison between multiple groups was performed by one-way ANOVA;Measurement data with non-normal distribution were described as M(P25,P75),and comparison between groups was done using Mann-Whitney U test.The comparison between counting data groups was performed by chi-square test.Results Ninety-two patients included in this study successfully completed the operation.One patient died during the perioperative period,with a mortality rate of 1.09％.The incidence of complications was 35.87％.Biliary tract infection and bile leakage were the most common complications.The incidence of complications was 14.13％ (13/92) and 9.78％ (9/92) respectively.The survival time of patients in the radical operation group 34.23(13.00,52.25) months was significantly different from that in the palliative operation group 4.75 (2.88,7.25) months (Z =-6.708,P =0.000).There was no significant difference in the survival time between the extended hepatectomy group 33.87 (13.00,56.00) months and the simple perihepatectomy group 34.54 (13.00,51.00) months (Z =-0.156,P =0.876).Univariate analysis showed that the factors related to the prognosis of hilar cholangiocarcinoma were preoperative history of calculi,tumor size,preoperative highest serum total bilirubin level,preoperative CA19-9 level,surgical modality ard tumor differentiation(HR =0.200,2.692,2.942,4.350,3.740,0.198;95％ CI:0.043-0.938,0.995-7.283,1.022-8.469,1.174-16.114,1.229-11.382,0.049 ～ 0.806,P ＜ 0.05).Multivariate analysis showed that tumor size,tumor differentiation and surgical modality were related to hilar cholangiocarcinoma.Surgical prognosis of patients with cholangiocarcinoma was significantly correlated (OR =1.034,6.444,12.527;95 ％ CI:1.007-1.062,1.012-41.037,3.187-49.243,P ＜0.05).Conclusions Radical resection is an effective way to improve the survival of patients with hilar cholangiocarcinoma.The effective grasp of surgical indications can improve the overall treatment prognosis.
RESUMO
Objective@#To exlore and analyze the curative effect and pognostic factors of surgical treatment for hilar cholangiocarcinoma.@*Methods@#The clinical data and prognosis of 92 patients with hilar cholangiocarcinoma admitted to Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2010 to January 2018 were retrospectively analyzed. There were 58 males and 34 females, with an age range of 35-81 years and average age of 61.3 years. Among them, 50 patients underwent radical resection of tumors (radical operation group), and 42 patients were discussed to undergo radical operation before operation, but only palliative resection of tumors or simple biliary drainage (palliative operation group) were performed because of the high location of tumors or distant metastasis during operation. Of the 50 patients who received radical surgery, 27 underwent simple perihepatic portectomy (perihepatic hilar resection group), and 23 underwent combined hepatic lobectomy (extended hepatectomy group). The incidence of perioperative complications, perioperative mortality and long-term survival rate of all patients were collected. The data of clinical cases included in the study were analyzed by univariate and multivariate analysis, and the relationship between perioperative mortality and prognosis survival time was discussed. The measurement data that accord with normal distribution were expressed by (Mean±SD). The comparison between the two groups was performed by t-test, the comparison between multiple groups was performed by one-way ANOVA; Measurement data with non-normal distribution were described as M(P25, P75), and comparison between groups was done using Mann-Whitney U test. The comparison between counting data groups was performed by chi-square test.@*Results@#Ninety-two patients included in this study successfully completed the operation. One patient died during the perioperative period, with a mortality rate of 1.09%. The incidence of complications was 35.87%. Biliary tract infection and bile leakage were the most common complications. The incidence of complications was 14.13%(13/92) and 9.78%(9/92) respectively. The survival time of patients in the radical operation group 34.23(13.00, 52.25) months was significantly different from that in the palliative operation group 4.75(2.88, 7.25) months (Z=-6.708, P=0.000). There was no significant difference in the survival time between the extended hepatectomy group 33.87(13.00, 56.00) months and the simple perihepatectomy group 34.54(13.00, 51.00) months (Z=-0.156, P=0.876). Univariate analysis showed that the factors related to the prognosis of hilar cholangiocarcinoma were preoperative history of calculi, tumor size, preoperative highest serum total bilirubin level, preoperative CA19-9 level, surgical modality and tumor differentiation(HR=0.200, 2.692, 2.942, 4.350, 3.740, 0.198; 95%CI: 0.043-0.938, 0.995-7.283, 1.022-8.469, 1.174-16.114, 1.229-11.382, 0.049~0.806, P<0.05). Multivariate analysis showed that tumor size, tumor differentiation and surgical modality were related to hilar cholangiocarcinoma. Surgical prognosis of patients with cholangiocarcinoma was significantly correlated(OR=1.034, 6.444, 12.527; 95%CI: 1.007-1.062, 1.012-41.037, 3.187-49.243, P<0.05).@*Conclusions@#Radical resection is an effective way to improve the survival of patients with hilar cholangiocarcinoma. The effective grasp of surgical indications can improve the overall treatment prognosis.
RESUMO
Objective@#To systematically evaluate the clinical efficacy of immunonutrition support in perioperative period of hepatectomy.@*Methods@#Literatures were researched using CNKI，CBM，Wanfang database，VIP databases，PubMed (Medline)，Embase，Web of science，Science Direct，Cochrane Center from January 1996 to March 2018 with the key words including "肝切除术，免疫营养，hepatectomy，hepatic resection，immunonutrition，immunoenhanced nutrition" . The randomized controlled trials (RCTs) on comparison of efficacy of immunonutrition support versus routine nutritional support in perioperative period of hepatectomy. Patients in the immunonutrition group received immunonutrition support in perioperative period of hepatectomy，and patients in the routine nutrition group received routine nutritional support in perioperative period of hepatectomy. Outcome measures：overall incidence of postoperative complications，incidence of postoperative infectious complications，incidence of postoperative liver failure，perioperative mortality，hospital stay，and hospitalization expenses. Literatures screening，data extraction and quality assessment of methodology were conducted by two researchers separately. Count data were represented as risk ratio (RR) and 95% confidence interval (CI). Measurement data were represented as mean difference (MD) or weighted mean difference (WMD) and 95%CI. Heterogeneity of the included studies was analyzed with I2. Funnel plot was used to test potential publication bias if the number of studies included ≥ 10，and funnel plot was used to test potential publication bias for the outcome measures with the maximum number of studies if the number of studies included <10.@*Results@#(1) Document retrival: 12 RCTs were enrolled in the Meta analysis, and the total sample size was 1 136 patients, including 568 patients in the immunonutrition group and in the routine nutrition group, respectively. (2) Results of Meta-analysis: the that immunonutrition group had lower overall incidence of postoperative complications, incidence of postoperative infectious complications, incidence of postoperative liver failure, and hospital stay (RR=0.57, 0.49, 0.30, MD=-3.28, 95%CI: 0.46-0.71, 0.37-0.65, 0.12-0.74, -4.45 to -2.11, P<0.05), and higher hospital expenses (MD=11.86, 95%CI: 10.96-12.77, P<0.05) compared with the routine nutrition group. There was no significant difference in the perioperative mortality between the two groups (RR=0.26, 95%CI: 0.07-1.05, P>0.05). The bilateral symmetry was presented in the funnel plot based on the 9 studies comparing incidence of postoperative infectious complications between the immunonutrition group and routine nutrition group, suggesting that publication bias had little influence on results of Meta-analysis.@*Conclusions@#Perioperative immunonutrition support for hepatectomy is safe and feasible. Compared with routine nutritional support, immunonutrition support can significantly reduce overall incidence of postoperative complications, incidence of postoperative infectious complications, incidence of postoperative liver failure, and shorten the hospital stay without increasing postoperative mortality.