外科手术对比经肝动脉栓塞治疗肝血管瘤的Meta分析

Meta-analysis of comparison between surgical operation and transarterial embolization in treatment of hepatic hemangioma

目的:系统评价外科手术与经肝动脉栓塞术(transarterial embolization,TAE)治疗肝血管瘤的临床效果及并发症情况。方法:检索数据库中关于外科手术对比TAE治疗肝血管瘤的临床对照研究文献,检索时限均自建库至2016年11月。2名研究员按照纳入与排除标准独立筛选文献、提取资料并评价质量,采用Rev Man 5.3软件作统计学分析。结果:最终6篇文献纳入研究,总病例数521例,其中326例接受外科手术治疗,295例接受TAE治疗。Meta分析结果显示:外科手术组复发率低于TAE组(OR=0.02,95%CI:0~0.08,P<0.05);外科手术组平均手术时间长于TAE组(OR=1.25,95%CI:0.88~1.62,P<0.05);外科手术组平均住院时间长于TAE组(OR=1.94,95%CI:1.50~2.39,P<0.05);外科手术组恢复正常工作时间长于TAE组(OR=1.18,95%CI:0.44~1.91,P=0.002);外科手术组平均住院费用(OR=0.25,95%CI:-1.04~1.53,P=0.71)和术后并发症发生率(OR=3.42,95%CI:0.96~12.25,P=0.06)与TAE组无明显差异。结论:外科手术和TAE均是治疗肝血管瘤的安全有效方式。外科手术治疗肝血管瘤复发率低,但手术时间、住院时间及恢复正常工作时间较长,两种治疗方式的近期并发症与治疗费用无显著差别。因此治疗方案的选择要结合上述因素综合考量。

Objective:To systematically evaluate and compare the surgical operation and transarterial embolization(TAE)in the treatment of hepatic hemangioma.Methods:The trials concerning surgical operation and TAE treatment for hepatic hemangioma were searched from database,including PubMed,Embase,Cochrane,China National Knowledge Internet(CNKI)and Wanfang Data.The retrieval time was from the establishment of database to November 2016,and the references in the literature were traced back.According to the inclusion and exclusion criteria,the selected scientific studies were separately screened by two researchers.The data were extracted and evaluated.RevMan 5.3 software was used to make statistical analysis.Results:Six studies were identified as eligible for inclusion in this analysis and included 521 patients with 326 treated with surgical operation and 295 with TAE.Our data analysis indicated that the recurrence rates(OR=0.02,95%CI:0.00-0.08,P<0.05)in surgical operation group were significantly lower than those in TAE group.Surgical operation group had significantly longer mean operation lasting time(OR=1.25,95%CI:0.88-1.62,P<0.05),hospitalization(OR=1.94,95%CI:1.50-2.39,P<0.05)and recovery time(OR=1.18,95%CI:0.44-1.91,P=0.002)than those in TAE group.Besides,overall cost(OR=0.25,95%CI:-1.04-1.53,P=0.71)and post-procedure complications rates(OR=3.42,95%CI:0.96-12.25,P=0.06)had no significant difference between two groups.Conclusions:Both surgical operation and TAE are safe and effective in the treatment of hepatic hemangioma.Surgical operation was superior to TAE in terms of tumor recurrence.However,surgical operation had longer operation lasting time,hospitalization and recovery time,and there was no significant difference in the cost and post?鄄procedure complications rates between two treatments.As a result,the treatment strategy should be determined based on the factors referred above.