目的：比较前入路右半肝切除术与传统入路右半肝切除术治疗肝癌的疗效和安全性。方法：计算机和人工检索比较前入路与传统入路右半肝切除术治疗肝癌疗效的对照研究的文献。按Cochrane系统评价要求对纳入研究进行评价，提取数据并用RevMan 5.3软件对数据进行Meta分析。结果：最终共纳入9篇对照研究，共1 344例患者，619例行前入路手术，725例行传统入路。Meta分析结果表明，前入路手术患者的1、3年总生存率（OR=1.85，95% CI=1.25~2.71，P=0.002；OR=3.11，95% CI=2.16~4.46，P<0.00001）与无瘤生存率（OR=2.27，95% CI=1.60~3.22，P<0.00001；OR=3.13，95% CI=2.11~4.64，P<0.00001）及围手术期病死率（OR=0.33，95% CI=0.15~0.70，P=0.004）优于传统入路患者；前入路患者与传统入路患者的手术时间、术中出血量、术后并发症发生率、住院时间差异无统计学意义（均P>0.05）。结论：前入路右半肝切除术技术上是安全的，与传统入路相比更符合肿瘤外科无瘤原则，可以提高肝癌患者总生存率、无瘤生存率并降低围手术期病死率。
Anterior approach versus conventional approach in right hemihepatectomy for liver cancer: a Meta-analysis
Objective: To compare the clinical efficacy of anterior approach and conventional approach in right hemihepatectomy for hepatocellular carcinoma. Methods: Literature on studies comparing anterior approach and conventional approach for right hemihepatectomy in treatment of hepatocellular carcinoma was obtained through computerized and manual searches. The quality of the included studies was assessed, according to the Cochrane guidelines, and after data extraction, the Meta-analysis was performed by RevMan 5.3 software. Results: Nine studies were finally included, involving 1 344 patients, of whom 619 cases received anterior approach operation and 725 cases underwent conventional approach operation. The results of Meta-analysis showed that patients undergoing anterior approach operation were superior to those undergoing conventional approach operation in 1, 3-year overall survival (OR=1.85, 95% CI=1.25–2.71, P=0.002; OR=3.11, 95% CI=2.16–4.46, P<0.00001) and disease free survival (OR=2.27, 95% CI=1.60–3.22, P<0.00001; OR=3.13, 95% CI=2.11–4.64, P<0.00001) as well as perioperative mortality (OR=0.33, 95% CI=0.15–0.70, P=0.004); there was no statistical difference in operative time, intraoperative blood loss, incidence of postoperative complications and length of hospital stay between patients undergoing anterior approach operation and conventional approach operation (all P>0.05). Conclusion: Anterior approach right hemihepatectomy is safe and better in meeting the tumor-free principle than conventional approach, and it can also improve the overall survival rate, disease-free survival rate and reduce perioperative mortality.