腹腔热灌注化疗治疗进展期大肠癌有效性及安全性的系统评价  

Efficacy and safety of hyperthermic intraperitoneal perfusion chemotherapy in treatment of advanced colorectal cancer: a systematic review

作　　者：李征[1,2] 张凯 米登海[1,2] 曹农[1] 温志震 余新林[2] 李忠信 LI Zheng1,2, ZHANG Kai3, MI Denghai1,2, CAO Nong1 , WEN Zhizhen2 , YU Xinlin2, LI Zhongxin2(1. Department of General Surgery, the First Hospital of Lanzhou University, Lanzhou 730000 ; 2. Department of Oncology, the Second People＇ s Hospital of Gansu Province; 3. Department of Infectious Diseases, the First Affiliated Hospital of Xi＇an Jiaotong University, Chin)

机构地区：[1]兰州大学第一医院普外科,甘肃兰州730000 [2]甘肃省第二人民医院肿瘤科 [3]西安交通大学第一附属医院感染科

出　　处：《胃肠病学和肝病学杂志》2018年第3期262-268,共7页Chinese Journal of Gastroenterology and Hepatology

基　　金：甘肃省卫生行业科研计划管理项目(GWGL-2013-4);甘肃省卫生行业科研计划项目(GSWSKY2014-14);甘肃省卫生创新人才工程专项基金资助项目(甘财社-2006-157号)

摘　　要：目的系统评价腹腔热灌注化疗(hyperthermic intraperitoneal perfusion chemotherapy,HIPC)治疗进展期大肠癌的有效性及安全性。方法系统检索Cochrane Library、Pub Med、EMBASE、Web of Science、CBM、CNKI、VIP及万方等数据库,配合补充检索手段,收集所有比较手术联合HIPC与单独手术的随机对照试验(randomized controlled trials,RCTs)。逐步进行文献筛选和资料提取,评估纳入文献的偏倚风险,应用Rev Man 5.3软件进行Meta分析。结果共纳入22篇RCTs(2 837例患者)。(1)有效性评价:HIPC组的1、2、3、5年生存率,总有效率和生活质量改善率均高于单独手术组,复发率和远处转移率均低于单独手术组,差异均有统计学意义(P<0.05)。(2)安全性评价:两组白细胞下降、恶心呕吐、肝脏损伤、肾脏损伤、肠梗阻、肠瘘、切口感染、出血和肺感染的发生率相比,差异均无统计学意义(P>0.05)。结论与单独手术相比,手术联合HIPC治疗进展期大肠癌可提高患者远期生存率和近期疗效,降低复发率和远处转移率,且并不增加并发症和不良反应发生率,但其安全性评价尚需进一步验证。Objective To systematically review the efficacy and safety of hyperthermic intraperitoneal perfusion chemotherapy（ HIPC） in treatment of advanced colorectal cancer,and to provide the reference for clinical practice and research. Methods Foreign databases as Cochrane Library,Pub Med,EMBASE,Web of Science and Chinese ones as CBM,CNKI,VIP and Wan Fang were searched by computer,and other sources were retrieved as supplying. All relevant randomized controlled trials（ RCTs） were collected to compare the efficacy and safety of surgery combined with HIPC and surgery without HIPC. After literature screening,data extraction and quality evaluation were independently conducted by two authors according to the protocal,Meta-analysis was performed by the Rev Man 5. 3 software. Results Twenty-two RCTs involving 2 837 patients were included. Meta-analysis showed：（ 1） the 1,2,3,5-year survival rates,total effective rate and improving rate of life quality of HIPC group were superior to those of surgery alone group,the recurrence rate and distant metastasis rate of HIPC group were lower than those of surgery alone group,there were significant differences（ P〈0. 05）;（2） there were no significant differences in the incidence of leukocytopenia,nausea and vomiting,hepatic lesion,renal lesion,ileus,intestinal fistula,infection of incisional wound,bleeding and pulmonary infection between two groups（ P〉0. 05）. Conclusion Compared with surgery alone,surgery combined with IHIC for advanced colorectal cancer can improve long-term survival rate and short-term curative effect,reduce recurrence and distant metastasis rate; additionally,it is safe and feasible. However,safety outcomes should be further evaluated by larger samples and high quality studies.

关 键 词：大肠癌 腹腔热灌注化疗 系统评价 Meta分析 随机对照试验 

分 类 号：R735.34[医药卫生—肿瘤]