病灶内切除与整块切除治疗骨巨细胞瘤的比较研究——4个相关研究的Meta分析

The study of intralesional excision compared with en-bloc resection for giant cell tumors of bone——a Meta--analysis for 4 relative studies

目的用Meta分析的方法对国内外已发表的高质量的有关比较病灶内切除术和整块切除术对骨巨细胞瘤患者术后复发率和并发症发生率影响的临床研究进行综合定量分析,为骨巨细胞瘤的外科治疗模式的选择提供参考依据。方法收集已公开发表的有关病灶内切除与整块切除治疗骨巨细胞瘤所有随访严密的随机对照研究或设计良好的非随机对照研究,按Meta分析的要求对检索到的原始研究的质量进行评估,对符合条件的所有研究结果用Meta分析专用统计软件RevMan4.2版进行统计分析,计算病灶内切除术相对整块切除术其复发及并发症发生危险的优势比(OR),评价病灶内切除术与整块切除术对GCT患者复发及并发症发生的影响。结果符合纳入标准的文献4篇,总样本量156例。其中病灶内切除术组83例,复发8例,发生并发症5例;整块切除术组73例,复发2例,发生并发症26例;合并OR复发=3.16,95%可信区间0.81～12.30,合并OR并发症=0.12,95%可信区间0.04～0.32。结论两种手术治疗模式对术后GCT复发的影响无统计学意义,还不能说明两种术式术后GCT复发率有差别。两种手术治疗模式对术后并发症发生的影响有统计学意义,病灶内切除组的并发症发生优势比整块切除组低88%。

Objective Search all studies that have been published in the world with regard to the effectiveness of the extent of intralesional excision and en-bloc resection for recurrence rate and complications in patients with giant cell turnouts of bone and analyze them which are in high quality by means of metaanalysis, in order to give some evidences for the choice of method dealing with GCT in surgery. Methods Evaluate strictly all the studies that have been searched and adopt the studies in high quality accord requirement of meta-analyze and analyze the studies by using meta- analysis software RevMan4.2. Calculate the odds ratio（OR） for recurrence rate and complication during the time to follow-up between the patients with intralesional excision and the patients with en-bloc resection. Evaluate the effectiveness of the extent of intralesional excision and en-bloc resection for recurrence rate and complication in patients with giant cell turnouts of bone. Results Totally 4 studies including 156 cases were analyzed. The cumulative cases in intralesional excision group were 83, in which 8 cases had local recurrence and 5 cases had complication; while in en-bloc resection group were 73, in which 8 cases had local recurrence and 5 cases had complication. The pooled ORrecurrence was 3.16, with a 95% confidence interval（0.81 - 12.30）, the pooled ORcomplication was 0.12, with a 95% confidence interval（0.04-0.32）. Conclusion There is no differ and statistically significant between the intralesional excision and en-bloc resection for recurrence rate. The result of analyze effectiveness of the extent of two treatment of GCT for complication is statistically significant, the overall OR for complication was decreased 0.88 in patients with intralesional excision compared with en-bloc resection.