CAJ | 학술논문

目的：系统评价外科手术与射频消融治疗直径3～5 cm的原发性肝癌的疗效。方法：计算机检索PubMed、中国生物医学文献数据库、中国知网、万方数据和维普数据库，收集关于射频消融与手术切除术治疗直径3～5 cm的原发性肝癌的临床对照研究文献，检索时限为1990年1月—2014年2月。由2位研究者根据纳入标准独立筛选文献、提取资料并评价质量后，采用 RevMan 5.0软件进行meta分析。结果：共纳入11个研究，包括1个随机对照试验和10个非随机对照试验。所纳入的研究共包含811例患者：其中直接采用射频消融术治疗的患者404例、外科手术切除的患者407例。 Meta分析表明：对于单个直径3～5 cm的原发性肝癌，手术组3、5年无瘤生存率高于射频消融组，差异有统计学意义（均 P ＜0.05），两者1、3、5年累积生存率及1年无瘤生存率差异无统计学意义（均P＞0.05）；对于1或2个直径均为3～5 cm的原发性肝癌，手术组的5年累积生存率及3、5年无瘤生存率高于射频消融组，差异有统计学意义（均P＜0.05），两者1、3年累积生存率及1年无瘤生存率差异无统计学意义（均P ＞0.05）；对于最大径为3～5 cm的多发性原发性肝癌，手术组的3年累积生存率高于射频消融组，差异有统计学意义（P ＜0.05），而两者1、5年累积生存率差异无统计学意义（均P ＞0.05）。结论：现有研究证据表明，对于直径3～5 cm的原发性肝癌，外科手术切除总体疗效优于射频消融治疗。受纳入研究质量和数量限制，上述结论尚需开展更多高质量研究加以验证。
목적：계통평개외과수술여사빈소융치료직경3～5 cm적원발성간암적료효。방법：계산궤검색PubMed、중국생물의학문헌수거고、중국지망、만방수거화유보수거고，수집관우사빈소융여수술절제술치료직경3～5 cm적원발성간암적림상대조연구문헌，검색시한위1990년1월—2014년2월。유2위연구자근거납입표준독립사선문헌、제취자료병평개질량후，채용 RevMan 5.0연건진행meta분석。결과：공납입11개연구，포괄1개수궤대조시험화10개비수궤대조시험。소납입적연구공포함811례환자：기중직접채용사빈소융술치료적환자404례、외과수술절제적환자407례。 Meta분석표명：대우단개직경3～5 cm적원발성간암，수술조3、5년무류생존솔고우사빈소융조，차이유통계학의의（균 P ＜0.05），량자1、3、5년루적생존솔급1년무류생존솔차이무통계학의의（균P＞0.05）；대우1혹2개직경균위3～5 cm적원발성간암，수술조적5년루적생존솔급3、5년무류생존솔고우사빈소융조，차이유통계학의의（균P＜0.05），량자1、3년루적생존솔급1년무류생존솔차이무통계학의의（균P ＞0.05）；대우최대경위3～5 cm적다발성원발성간암，수술조적3년루적생존솔고우사빈소융조，차이유통계학의의（P ＜0.05），이량자1、5년루적생존솔차이무통계학의의（균P ＞0.05）。결론：현유연구증거표명，대우직경3～5 cm적원발성간암，외과수술절제총체료효우우사빈소융치료。수납입연구질량화수량한제，상술결론상수개전경다고질량연구가이험증。
Objective: To compare the therapeutic effects of surgical hepatic resection ( HR ) and radiofrequency ablation ( RFA ) in treatment of primary hepatocellular carcinoma of 3-5 cm in diameter.Methods: The databases PubMed, CBMdisc, CNKI, WanFang Data and VIP databases were searched for controlled clinical trials on evaluating the efficacy between RFA and HR in treatment of primary hepatocellular carcinoma of 3-5 cm in diameter published from January 1990 to February 2014.Two reviewers independently screened the literature, extracted the data and assessed the methodological quality of the studies included.Then the meta-analysis was performed by using RevMan5.0 software.Results:Eleven controlled clinical trials were included, including one randomized controlled trial and 10 non-randomized controlled trials.A total of 811 patients were involved:404 patients were treated with RFA as the initial treatment and 407 patients with surgical resection.Meta-analysis showed that for a single lesion with diameter of 3-5 cm of primary hepatocellular carcinoma, the 3-, 5-year disease-free survival rates in HR group was significantly higher than those in RFA group ( all P<0.05) .There were no significant difference in the 1-, 3-, 5-year overall survival rates and 1-year disease-free survival rate between RFA group and HR group ( P>0.05 ) .For 1-2 nodules with diameters of 3-5 cm of primary hepatocellular carcinoma, the 3-, 5-year disease-free survival rates and 5-year overall survival rates in HR group was significantly higher than those in RFA group ( all P<0.05 ) .No significant difference in 1-, 3-year overall survival rates and 1-year disease-free survival rate was found between RFA group and HR group ( P>0.05 ) . For maximum nodule of 3-5 cm of multiple primary hepatocellular carcinoma, the 5-year overall survival rates in HR group was significantly higher than that in RFA group ( all P<0.05 ) .No significant difference in 1-, 5-year overall survival rates was noted between RFA group and HR group ( P >0.05 ) . Conclusion: For primary hepatocellular carcinoma of 3-5 cm in diameter, HR is better than RFA.For the limitation of quality and quantity of included studies, this conclusion needs to be confirmed by more high quality studies.