急诊肝切除与急诊肝动脉栓塞联合二期肝切除治疗 原发性肝癌破裂出血疗效比较的Meta分析
| 作者: |
1刘文晖,
1张贤彬,
1韩洋,
1巩鹏
1 大连医科大学附属第一医院 肝胆外科，辽宁 大连 116011 |
| 通讯: |
巩鹏
Email: gongpengdalian@163.com |
| DOI: | 10.3978/.2018.01.002 |
| 基金: | 国家自然科学基金资助项目（81473504）。 |
摘要
目的：比较急诊肝切除与急诊肝动脉栓塞联合二期肝切除治疗原发性肝癌破（HCC）裂出血的临床疗效。
方法：通过系统检索多个国内外文献数据库，并按照纳入与排除标准，筛选符合标准的文献，用StataSE 12.0进行Meta分析。
结果：共纳入11篇文献，581例患者，其中305例行急诊肝切除，276例行急诊肝动脉栓塞+二期肝切除。与急诊肝切除患者比较，急诊肝动脉栓塞联合二期肝切除患者围手术期并发症发生率降低（OR=0.39，95% CI=0.21~0.72，P=0.003），30 d病死率降低（OR=0.21，95% CI=0.08~0.56，P=0.002），1、3年生存率升高（OR=0.48，95% CI=0.32~0.73，P=0.001；OR=0.59，95% CI=0.37~0.95，P=0.031）。
结论：对于可切除的HCC自发破裂出血，急诊肝动脉栓塞联合二期肝切除治疗较急诊肝切除可显著降低围手术期并发症、病死率，并明显提高患者生存率。
关键词：
癌，肝细胞；破裂，自发性；肝切除术；栓塞，治疗性；Meta分析
方法：通过系统检索多个国内外文献数据库，并按照纳入与排除标准，筛选符合标准的文献，用StataSE 12.0进行Meta分析。
结果：共纳入11篇文献，581例患者，其中305例行急诊肝切除，276例行急诊肝动脉栓塞+二期肝切除。与急诊肝切除患者比较，急诊肝动脉栓塞联合二期肝切除患者围手术期并发症发生率降低（OR=0.39，95% CI=0.21~0.72，P=0.003），30 d病死率降低（OR=0.21，95% CI=0.08~0.56，P=0.002），1、3年生存率升高（OR=0.48，95% CI=0.32~0.73，P=0.001；OR=0.59，95% CI=0.37~0.95，P=0.031）。
结论：对于可切除的HCC自发破裂出血，急诊肝动脉栓塞联合二期肝切除治疗较急诊肝切除可显著降低围手术期并发症、病死率，并明显提高患者生存率。
Emergency hepatectomy versus emergency transcatheter arterial embolization plus second-stage hepatectomy for spontaneous ruptured hepatocellular carcinoma: a Meta-analysis
CorrespondingAuthor:GONG Peng Email: gongpengdalian@163.com
Abstract
Objective: To compare the therapeutic effects between emergency hepatectomy and emergency transcatheter arterial embolization (TAE) plus second-stage hepatectomy in treatment of spontaneous ruptured hepatocellular carcinoma (HCC).
Methods: By searching several domestic and international databases, the eligible literature of studies was screened according to inclusion and exclusion criteria. Meta-analysis was performed by using StataSE 12.0 software.
Results: A total of 11 studies were included, involving 581 patients, of whom, 305 cases underwent emergency hepatectomy and 276 underwent emergency TAE plus second-stage hepatectomy. In patients undergoing emergency TAE plus second-stage hepatectomy compared with those undergoing emergency hepatectomy, the incidence of perioperative complications was significantly decreased (OR=0.39, 95% CI=0.21–0.72, P=0.003), the 30-d mortality rate was significantly reduced (OR=0.21, 95% CI=0.08–0.56, P=0.002), and the 1- and 3-year survival rates were significantly increased (OR=0.48, 95% CI=0.32–0.73, P=0.001; OR=0.59, 95% CI=0.37–0.95, P=0.031).
Conclusion: For resectable spontaneous ruptured HCC, emergency TAE plus second-stage hepatectomy can significantly reduce perioperative complications and mortality rate and increase survival rate of the patients compared with emergency hepatectomy.
Keywords：
Carcinoma
Hepatocellular; Rupture
Spontaneous; Hepatectomy; Embolization
Therapeutic; Meta-Analysis
Methods: By searching several domestic and international databases, the eligible literature of studies was screened according to inclusion and exclusion criteria. Meta-analysis was performed by using StataSE 12.0 software.
Results: A total of 11 studies were included, involving 581 patients, of whom, 305 cases underwent emergency hepatectomy and 276 underwent emergency TAE plus second-stage hepatectomy. In patients undergoing emergency TAE plus second-stage hepatectomy compared with those undergoing emergency hepatectomy, the incidence of perioperative complications was significantly decreased (OR=0.39, 95% CI=0.21–0.72, P=0.003), the 30-d mortality rate was significantly reduced (OR=0.21, 95% CI=0.08–0.56, P=0.002), and the 1- and 3-year survival rates were significantly increased (OR=0.48, 95% CI=0.32–0.73, P=0.001; OR=0.59, 95% CI=0.37–0.95, P=0.031).
Conclusion: For resectable spontaneous ruptured HCC, emergency TAE plus second-stage hepatectomy can significantly reduce perioperative complications and mortality rate and increase survival rate of the patients compared with emergency hepatectomy.