中晚期肝细胞肝癌介入治疗的循证临床实践二年随访观察  

Evidenced-based clinical practice of interventional therapy for advanced hepatocellular carcinoma：2-year follow-up results in 59 cases

作　　者：李保国[1] 温浩[1] 郭志[2] 王海涛[2] 

机构地区：[1]新疆医科大学第一附属医院肝移植腔镜外科,乌鲁木齐830054 [2]天津医科大学附属肿瘤医院介入治疗科天津市肿瘤防治重点实验室

出　　处：《中华医学杂志》2010年第18期1255-1259,共5页National Medical Journal of China

基　　金：国家科技支撑计划课题（2007BAI05B06）

摘　　要：目的 探讨借助循证医学方法为中晚期肝细胞肝癌患者确定介入治疗目标以及治疗方案的效果.方法 在充分评价肝癌介入治疗现状后,提出临床问题,从EBSCO、Cochrane图书馆（2007年第1期）、Medline（1990年1月至2007年1月）、ACP Journal Club（1991年1月至2007年1月）和http：//sumsearch.uthsea. Edu/searchform4.htm上进行检索,检索主题词：肝细胞肝癌、介入治疗、系统评价、荟萃分析等.对检索获得的循证医学证据进行分析评价并制定合理的循证介入治疗方案后,纳入患者实施治疗;与同期收治的纳入标准一致但按照传统方式进行介入治疗的患者进行比较,观察该方案的有效性及两组病例的治疗获益差别.统计处理采用SPSS 16.0统计软件,用Kaplan-Meier法绘制生存曲线,运用时序检验Log-rank进行统计学显著性分析,组间率的比较采用x2检验.结果 共检索出与不同问题相关的随机对照试验9篇,系统评价和荟萃分析3篇.总共纳入了119例患者,59例实施循证介入治疗,60例接受传统方式的介入治疗.连续随访2年证实,循证介入治疗方案更适合本组患者,1、2年生存率分别为79.7%、50.8%,而非循证介入治疗组分别为68.3%、31.7%,两组比较差异具有统计学意义（P＜0.05）.结论 运用循证治疗的方法为中晚期肝癌患者确定合理的治疗方案,有助于提高介入治疗的疗效、增加患者的生存获益.Objective To explore the methods of evidence-based medicine to determine objectives and evaluate the efficacy of interventional therapy for advanced hepatocellular carcinoma. Methods Clinical questions were raised after a thorough evaluation of the status of interventional therapy. The term of evidence based medicine methods was searched in EBSCO, Cochrane library, Medline （January 1990 -January 2007 ）, ACP Journal Club （January 1991 -January 2007 ） and Sumsearch. The searching subjects were hepatocellular carcinoma, interventional therapy, systematic review and meta-analysis etc. Based upon an analysis of the searching results, rational evidence based interventional therapy regimes were made. The survival benefit was studied by comparing with the empirical counterpart of the same period and with the same inclusion criteria. Data and Kaplan-Meier survival analyses were conducted by SPSS version 16. 0software. Results Nine randomized controlled clinical trials related to clinical questions and three systematic reviews were retrieved. A total of 119 cases of hepatocellular carcinoma were included. The evidence-based interventional therapy was performed in 59 cases and empirical interventional therapy in other 60 cases. The 2-year follow-up results confirmed that the evidence-based regimes were more appropriate for advanced hepatocellular carcinoma. The 1 and 2-year overall survival rates in evidence-based interventional therapy group and empirical group were 79. 7% vs 68. 3% and 50. 8% vs 31.7% respectively. And the difference was significant （P〈0. 05）. Conclusion Choosing the therapeutic regimes according to evidence-based medicinemethods can increase the clinical efficacy of interventional therapy and achieve survival benefits.

关 键 词：癌 肝细胞 循证医学 肝动脉化疗栓塞 肝动脉栓塞 

分 类 号：R735.7[医药卫生—肿瘤]