CAJ | 학술논문

目的利用meta分析的方法,评价经皮射频消融与手术切除治疗符合Milan标准的小肝癌的疗效.方法选取发表于1990年1月至2010年2月的文献,对比分析经皮射频消融与手术切除两种方式治疗符合Milan标准的小肝癌疗效的临床随机对照试验研究,并应用meta分析方法评价总体生存率以及术后复发率等相关指标.结果共有4篇前瞻性随机对照研究纳入此分析,包括539例患者,其中经皮射频消融治疗252例患者,手术切除治疗287例患者.经皮射频消融与手术切除治疗患者之间术后总体生存率的差异无统计学意义(P＞0.05);经皮射频消融术治疗患者术后2、3、4年无瘤生存率均低于手术切除,差异有统计学意义(P＜0.05).经皮射频消融术治疗患者术后肿瘤复发率高于手术切除,差异有统计学意义( OR:2.63,95％ CI:1.67～4.15,P=0.000).经皮射频消融术治疗患者术后并发症的发生率低于手术切除,差异有统计学意义( OR:0.14,95％CI:0.09～0.22,P=0.000).结论对于符合Milan标准且适应手术切除和经皮射频消融治疗指征的小肝癌,经皮射频消融与手术切除治疗患者的术后总体生存率相似.经皮射频消融具有侵袭性小、术后并发症发生率低等优点,但是手术切除能够较好的预防术后肿瘤复发.对于不愿意行手术切除的患者,可推荐选择经皮射频消融治疗.
목적 이용meta분석적방법,평개경피사빈소융여수술절제치료부합Milan표준적소간암적료효.방법 선취발표우1990년1월지2010년2월적문헌,대비분석경피사빈소융여수술절제량충방식치료부합Milan표준적소간암료효적림상수궤대조시험연구,병응용meta분석방법평개총체생존솔이급술후복발솔등상관지표.결과 공유4편전첨성수궤대조연구납입차분석,포괄539례환자,기중경피사빈소융치료252례환자,수술절제치료287례환자.경피사빈소융여수술절제치료환자지간술후총체생존솔적차이무통계학의의(P＞0.05);경피사빈소융술치료환자술후2、3、4년무류생존솔균저우수술절제,차이유통계학의의(P＜0.05).경피사빈소융술치료환자술후종류복발솔고우수술절제,차이유통계학의의( OR:2.63,95％ CI:1.67～4.15,P=0.000).경피사빈소융술치료환자술후병발증적발생솔저우수술절제,차이유통계학의의( OR:0.14,95％CI:0.09～0.22,P=0.000).결론 대우부합Milan표준차괄응수술절제화경피사빈소융치료지정적소간암,경피사빈소융여수술절제치료환자적술후총체생존솔상사.경피사빈소융구유침습성소、술후병발증발생솔저등우점,단시수술절제능구교호적예방술후종류복발.대우불원의행수술절제적환자,가추천선택경피사빈소융치료.
Objective To evaluate the curative effect of percutaneous radiofrequency ablation (RFA) and hepatic resection (RES)for small hepatocarcinoma eligibled for Milan criterion using meta analysis method.Methods Retrieved clinical trials comparing percutaneous radiofrequency ablation with RES for small hepatocarcinoma published from 1990 to 2010.A meta-analysis was conducted to estimate overall survival and disease free survival.A fixed random effect model or random effect model was established to collect the data.Results Four randomized controlled trials were included in this analysis.These studies included a total of 539 patients:252 treated with percutaneous RFA and 287 treated with RES.The differences in overall survival were not statistically significant between RFA and RES ( P ＞ 0.05 ).In the patients treated with RES group,the 2-,3- and 4- years disease free survival rates were significantly better than that in the patients treated with percutaneous RFA ( P ＜ 0.05 ).The postoperative morbidity rate was significant lower in patients treated with percutaneous RFA( OR:0.14,95％ CI:0.09-0.22,P =0.000).But percutaneous RFA had a higher rate of tumor recurrence compared to RES( OR:2.63,95％ CI:1.67-4.15,P =0.000).Conclusions For small hepatocarcinoma eligibled for Milan criterion,percutaneous RFA had a similar overall survival to RES.Percutaneous RFA was the invasive lesser and had a lower postoperative morbidity rate than RES,but RES may had a better prevention of the tumor recurrence than percutaneous RFA.For those patients who don't want to be treated by RES,percutsneous RFA may be a recommendable choice.