姑息性手术加药物和单纯性药物治疗肝泡状棘球蚴病的循证医学效果评价

Palliative surgery and chemotherapy compared with only chemotherapy for the alveolar echinococcosis

目的系统评价姑息性手术加药物和单纯性药物治疗对肝泡状棘球蚴病患者预后的影响。方法计算机检索Cochrane图书馆、MEDLINE、EMBASE;中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(全文版)和中国期刊全文数据库。根据所得文献的参考文献追踪检索。按Cochrane系统评价方法评价纳入研究质量,并进行描述性分析。结果未检索到随机对照研究。共纳入2个非随机对照研究,包括159例患者,姑息性手术加药物组56例,单纯性药物组103例。2个研究的合并分析结果表明:①15年生存概率:姑息性手术加药物组与单纯性药物组比较,两组差异没有显著性〔OR=1.04,95%C(I0.50,2.17)〕;②并发症发生率:姑息性手术加药物组与单纯性药物组比较,两组差异没有显著性〔OR=1.56,95%C(I0.77,3.15)〕。另一研究显示姑息性手术加药物组患者病情更容易恶化(P<0.0001)。另一研究显示姑息性手术加药物组的影像学改善率好于单纯性药物组(P=0.008)。结论现有证据表明,在患者生存概率和并发症发生率方面,姑息性手术加药物治疗和单纯性药物治疗的作用相同,二者无区别。此外姑息性手术加药物治疗可能会恶化包虫病患者的病情,导致患者死亡等。

[Objective] To evaluate the prognostic value of the surgery combined with chemotherapy and only chemotherapy for hepatic alveolar echinococcosis（HAE）.[Methods] We searched The Cochrane Library,MEDLINE,EMBASE,the Chinese Biomedicine Database,Chinese scientific and technical journals full-text database and Chinese Journal of the full text database.The quality of the included trials was evaluated by two reviewers independently.[Results] There were not any randomized controlled trials identified.Only two studies involving 159 cases met the inclusion criteria and both of them were non-randomized controlled trials.The meta analysis of the two studies showed that：①there was not any statistical difference of the survival rate for 15 years between the surgery combined with chemotherapy and only chemotherapy [OR=1.04,95%CI（0.50,2.17）];②there was not any statistical difference of the rate of complications between the two treatments [OR=1.56,95%CI（0.77,3.15）].One study showed that patients with HAE deteriorated easily after the surgery combined with chemotherapy（P 0.0001） and another one proposed that imaging features of HAE were improved by the surgery combined with chemotherapy（P =0.008）.[Conclusion] In the treatment of HAE,surgery combined with chemotherapy is similar in the improving the rate of survival and complications to only chemotherapy.