急诊切除或肝动脉栓塞术后二期切除治疗肝癌自发破裂出血近远期疗效的荟萃分析  

Short- and long-term outcomes of emergency resection versus transarterial embolization followed by resection for spontaneous rupture hepatocellular carcinoma: a meta-analysis

作　　者：黄小准 王春玲 黄璋侃 徐林 殷鑫 毕新宇 车旭 倪勇[4] Huang Xiaozhun;Wang Chunling;Huang Zhangkan;Xu Lin;Yin Xin;Bi Xinyu;Che Xu;Ni Yong(The Graduate School of Guangzhou Medical University,Guangzhou 511436,China;National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen 518116,China;National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Second People's Hospital,First Affiliated Hospital of Shenzhen University,Shenzhen 518035,China)

机构地区：[1]广州医科大学研究生院,广州511436 [2]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院深圳医院,深圳518116 [3]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院,北京100021 [4]深圳市第二人民医院,深圳大学第一附属医院,深圳518035

出　　处：《中华肝胆外科杂志》2021年第11期852-857,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：深圳市“医疗卫生三名工程”项目(SZSM202011010,SZSM201812079);深圳市高水平医院建设专项经费。

摘　　要：目的通过荟萃分析探究肝细胞癌自发性破裂出血患者的最佳手术治疗策略。方法系统检索PubMed、Web of Science、Embase以及Cochrane Library数据库,通过纳入和排除标准筛选出比较急诊肝部分切除(ER)和经肝动脉栓塞术后二期手术(SH)的合格研究,并使用Review Manager 5.3软件对报告的围手术期指标和生存数据进行统计汇总及分析。结果共纳入8篇回顾性研究,总样本量556例,其中ER组285例(51.3%),SH组271例(48.7%)。荟萃分析结果显示,SH组的围手术期失血量(WMD=683.61,95%CI:283.36~1083.86,P=0.0008)及输血量(WMD=453.43,95%CI:250.27~656.58,P<0.0001)均少于ER组,差异有统计学意义;两组之间的手术时间、并发症发生率、病死率以及肿瘤复发率差异无统计学意义(均P>0.05)。ER组的1、2、3年总生存率和1、2、3、5年无病生存期与SH组比较差异无统计学意义(均P>0.05),但ER组5年总生存率低于SH组(HR=1.52,95%CI:1.14~2.03,P=0.005)。结论ER或SH在治疗肝癌破裂出血的近期疗效方面无明显差别,SH在远期生存方面优于ER。Objective To study the optimal surgical strategy for patients with hepatocellular carcinoma(HCC)presenting with spontaneous rupture and hemorrhage.Methods The electronic databases of PubMed,Web of Science,Embase,and Cochrane Library were searched,and studies reporting on survival outcomes comparing emergency resection(ER)and transarterial embolization followed by hepatectomy(SH)were included by using predetermined inclusion and exclusion criteria.The perioperative and survival data were compared using the Review Manager 5.3 software.Results Eight retrospective studies were included.The total sample size was 556,with 285(51.3%)in the ER group and 271(48.7%)in the SH group.Perioperative blood loss(WMD=683.61,95%CI:283.36-1083.86,P=0.0008)and blood transfusion volume(WMD=453.43,95%CI:250.27-656.58,P<0.0001)in the SH group were significantly less than those in the ER group.There were no significant differences in operative time,incidences of complications,mortality and recurrence rates of tumors between the two groups(all P>0.05).The 1-,2-,3-year overall survival and 1-,2-,3-,5-year disease-free survival of the ER group were not significantly different from those of the SH group(all P>0.05).The 5-year overall survival rate of the ER group was significantly lower than that of the SH group(HR=1.52;95%CI:1.14-2.03,P=0.005).Conclusions There was no significant difference in short-term outcomes in treatment of ruptured HCC,SH was superior to ER in long-term survival outcomes.

关 键 词：癌 肝细胞 自发破裂 肝部分切除 肝动脉栓塞 荟萃分析 

分 类 号：R735.7[医药卫生—肿瘤]