急诊肝动脉栓塞联合二期肝部分切除治疗原发性肝癌破裂出血疗效Meta分析

Emergency Transcatheter Arterial Embolization Combined with Two-stage Liver Resection for Spontaneous Ruptured Hepatocellular Carcinoma: A Systematic Review and Meta-analysis

目的探讨急诊肝动脉栓塞(transcatheter arterial embolization,TAE)联合二期肝部分切除与急诊肝部分切除治疗原发性肝癌(hepatocellular carcinoma,HCC)破裂出血的疗效区别。方法通过计算机及手工搜索国内外关于急诊TAE联合二期肝部分切除与急诊肝部分切除治疗HCC破裂出血效果对比的文献,按照纳入标准选择文献,提取相关数据,应用Rev Man5.3软件进行统计学分析。结果共纳入文献5篇,与急诊肝部分切除组相比,急诊TAE联合二期肝部分切除组患者并发症发生率明显降低(OR=0.27,95%CI:0.03~0.40,P=0.008),1、2、3年生存率无明显升高(1年生存率:OR=1.63,95%CI:0.84~3.16,P=0.15;2年生存率:OR=1.40,95%CI:0.63~3.11,P=0.41;3年生存率:OR=1.13,95%CI:0.48~2.68,P=0.78)。结论急诊TAE联合二期肝部分切除治疗HCC破裂出血,与急诊肝部分切除相比,可显著降低围手术期并发症,1、2、3年生存率组间比较差异无统计学意义,在手术后短期内使患者受益更大。

Objective To compare the therapeutic effect of emergency transcatheter arterial embolization(TAE) plus two-stage liver resection with emergency liver resection for spontaneous ruptured hepatocellular carcinoma(HCC). Methods We collected the medical literatures published at home and abroad concerning the clinical results of emergency TAE plus two-stage liver resection and emergency liver resection in treating spontaneous ruptured HCC through electronic or manual searching. Literatures that met the inclusion criteria were reviewed systematically, and the reported data were aggregated statistically using Rev Man5.3 software. Results A total of 5 academic papers were enrolled. The complication rate of emergency TAE plus two-stage liver resection group was significantly lower than that of emergency liver resection group(OR=0.27, 95%CI:0.03-0.40, P=0.008); moreover, no significant difference in 1-, 2-, 3-year survival rate existed between two groups(1-year survival rate: OR=1.63, 95%CI:0.84-3.16, P=0.15; 2-year survival rate: OR=1.40, 95%CI:0.63-3.11, P=0.41; 3-year survival rate: OR=1.13, 95%CI:0.48-2.68, P=0.78). Conclusion Emergency TAE combined with two-stage liver resection could reduce perioperative complication rate and make patients get the greater benefit after surgery in the short term, compared with emergency liver resection in treating ruptured HCC.