肝动脉栓塞术与肝切除术治疗肝癌自发性破裂出血效果的Meta分析

摘要

目的：评价肝动脉栓塞术与手术治疗肝癌自发性破裂出血的效果。方法检索中国知网、万方、维普、PubMed、Cochrane图书馆、EMbase中关于肝动脉栓塞术(试验组)与肝切除术治疗(对照组)肝癌自发性破裂出血的随机对照试验,同时筛检纳入文献的参考文献,并对文献质量进行严格评价和资料提取,对符合质量标准的研究使用RevMan 5.1进行Meta分析。结果符合纳入标准的共10篇文献,总样本量为343例。 Meta分析显示,治疗终点时试验组术后并发症少于对照组(OR =0.23,95%CI：0.1~0.55,P越0.0009),两组在止血效果和1年生存率方面差异无统计学意义(OR =1.05,95%CI：0.23~4.74,P越0.95；OR =1.00,95%CI：0.49~2.03,P越0.99)。结论肝动脉栓塞术可以作为治疗肝癌破裂出血的首选手段。%Objective To review the effectiveness of transcatheter arterial embolization and surgical treatments for spontaneous rupture of hepatocellular carcinoma with hemorrhage. Methods The documents of randomized controlled trials (RCT) which related to the efficacy of transcatheter arterial embolization (experimental group) and surgical treat-ments for spontaneous rupture (control group) of hepatocellular carcinoma with hemorrhage were retrieved from the databases of CNKI, CBM, VIP, PubMed, Cochrane, EMbase and the reference of these RCT were retrieved by hands at the same time. The documents were screened, extracted and evaluated according to inclusion and exclusion criteria, and then given a Meta-analysis by using RevMan 5.1 softwarel. Results There were totally 10 RCTs (343 patients) includ-ed.The results of Meta-analysis showed that: complications after surgery in the experimental group were better than that of control group (OR =0.23, 95%CI 0.1-0.55, P=0.0009), while its hemostatic effect and one-year survival rate in the two groups (OR =1.05, 95%CI 0.23-4.74, P=0.95;OR =1.00, 95%CI 0.49-2.03, P=0.99) had no statistical difference. Conclusion Transcatheter arterial embolization is the first choice of treatments for spontaneous rupture of hepatocellular carcinoma with hemorrhage.