本文關(guān)鍵詞： 原發(fā)性肝細(xì)胞肝癌 肝切除 TACE Meta分析 療效 生存率　出處：《遵義醫(yī)學(xué)院》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:術(shù)前預(yù)防性TACE及術(shù)后TACE能否改善可切除的原發(fā)性肝細(xì)胞肝癌患者臨床療效目前仍存在爭議,本研究旨在通過Meta分析評價術(shù)前預(yù)防性TACE及術(shù)后TACE對可切除的原發(fā)性肝細(xì)胞肝癌患者的治療價值。方法:計算機(jī)檢索中文數(shù)據(jù)庫中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫、中國知網(wǎng)、維普、萬方數(shù)據(jù)庫及外文數(shù)據(jù)庫Pub Med、OVID、Embase、Cochrane library的相關(guān)文獻(xiàn),所有文獻(xiàn)均截止于2016年1月。由兩位評價員篩選、提取、核對數(shù)據(jù),使用改良后的Jadad質(zhì)量評分表對所納入的隨機(jī)對照試驗(yàn)進(jìn)行文獻(xiàn)質(zhì)量評價,病例對照研究采用Newcastle-Ottawa?Scale文獻(xiàn)質(zhì)量評分表進(jìn)行質(zhì)量評估。對符合納入標(biāo)準(zhǔn)的研究采用Stata12.0軟件進(jìn)行統(tǒng)計分析。結(jié)果:根據(jù)原發(fā)性肝細(xì)胞肝癌患者肝切除術(shù)前是否行預(yù)防性TACE分為術(shù)前預(yù)防性TACE聯(lián)合切肝組(術(shù)前TACE組)和單獨(dú)肝切除術(shù)組(LR組),兩組的比較共納入11篇文獻(xiàn),其中3篇隨機(jī)對照試驗(yàn)(RCT)及8篇病例對照研究,共納入2316例患者(術(shù)前預(yù)防性TACE聯(lián)合切肝組752例,單獨(dú)肝切除術(shù)1564例)。結(jié)果顯示:術(shù)前預(yù)防性TACE聯(lián)合切肝組與單獨(dú)肝切除術(shù)組的比較手術(shù)時間、術(shù)中出血量均無顯著性差異(手術(shù)時間:SMD=0.058,95%CI:-0.166,0.050,P=0.290;術(shù)中出血量:SMD=-0.098,95%CI:-0.204,-0.08,P=0.070),住院時間的比較差異有統(tǒng)計學(xué)意義(SMD=-0.86,95%CI:-1.57,-0.14,P=0.02),術(shù)前TACE住院時間明顯增加。生存率:兩組3年總體生存率與5年總體生存率的比較差異無統(tǒng)計學(xué)意義(3年總體生存率的比較:RR=1.039,95%CI:0.964,1.121,P=0.314;5年總體生存率的比較:RR=0.96,95%CI:0.86,1.08,P=0.505)。根據(jù)原發(fā)性肝細(xì)胞肝癌患者肝切除術(shù)后是否行TACE治療分為術(shù)后TACE組與單獨(dú)肝切除術(shù)組,兩組的比較共納入RCT1篇及病例對照研究14篇,共納入2184例患者(肝切除術(shù)聯(lián)合術(shù)后TACE組1097例,單獨(dú)肝切除術(shù)1087例)。結(jié)果顯示:HCC患者手術(shù)后TACE治療能改善原發(fā)性肝細(xì)胞肝癌患者的1年總體生存率(1年總體生存率比較:RR=1.13,95%CI:1.03,1.24,P=0.010),本研究根據(jù)HCC患者的臨床資料是否存在腫瘤直徑大于5cm;多發(fā)結(jié)節(jié);血管侵犯行亞組分析,結(jié)果顯示手術(shù)后TACE治療在伴有以上情況的分組中有重要的價值(亞組分析無危險因素組:RR=1.10,95%CI:0.97,1.25,P=0.140;伴危險因素組:RR=1.16,95%CI:1.02,1.32,P=0.028)。3年總體生存率的比較:手術(shù)后TACE治療能顯著改善原發(fā)性肝細(xì)胞肝癌患者的3年總體生存率(3年總體生存率的比較:RR=1.33,95%CI:1.15,1.53,P=0.000),手術(shù)后TACE治療對改善原發(fā)性肝細(xì)胞肝癌患者5年總體生存率無明顯作用(5年總體生存率的比較:RR=1.21,95%CI:0.95,1.15,P=0.124)。結(jié)論:1、HCC患者行術(shù)前TACE治療不能縮短手術(shù)時間、降低術(shù)中出血量,延長了住院時間,對遠(yuǎn)期生存率亦無明顯改善。2、HCC患者手術(shù)后TACE治療能改善原發(fā)性肝細(xì)胞肝癌患者的1年、3年生存率,對HCC患者合并腫瘤直徑大于5cm、多發(fā)結(jié)節(jié)、血管侵犯的情況下有重要的治療價值,手術(shù)后行TACE可作為一種常規(guī)的治療方式。
[Abstract]:Objective: whether preoperative prophylactic TACE and postoperative TACE can improve the clinical efficacy of resectable primary hepatocellular carcinoma (HCC) is still controversial. The purpose of this study was to evaluate the value of preoperative prophylactic TACE and postoperative TACE in the treatment of resectable primary hepatocellular carcinoma (HCC) by Meta analysis. The literature on Wanfang Database and Foreign language Database Pub library is as of January 2016. The data are screened, extracted and checked by two evaluators. The literature quality of the randomized controlled trial was evaluated using the improved Jadad quality scoring table, and the case control study was conducted using Newcastle-Ottawaa? Scale document quality score table was used to evaluate the quality. Stata12.0 software was used to analyze the quality of the patients who met the inclusion criteria. Results: according to whether preventive TACE was performed before hepatectomy in patients with primary hepatocellular carcinoma (HCC), preventive TACE was classified as preoperative prevention. Sex TACE combined with hepatectomy (TACE group) and hepatectomy alone group (LR group), the comparison of the two groups included 11 articles. Three randomized controlled trials (RCTs) and eight case-control studies were conducted in 2316 patients (752 patients with prophylactic TACE combined with hepatectomy before operation). The results showed that the operative time of preoperative prophylactic TACE combined with hepatectomy group was compared with that of single hepatectomy group. There was no significant difference in intraoperative bleeding volume (operation time: SMD-0.058% CI: -0.166% 0.050 / P0.290; intraoperative bleeding volume: SMD-0.09895 CI-0.204 ~ -0.08% P0.0700.The difference in hospitalization time was statistically significant (SMD-0.8695 CI-1 CI-1.57U -0.14P0.02), preoperative TACE hospitalization time was significantly increased. Survival rate: the overall survival rate of the two groups was 3 years and 5 years. There was no significant difference in the overall survival rate between the two groups. (comparison of 3-year overall survival rate: 1. 039% CI: 0. 964 + 1. 121% P0. 314; comparison of 5 year overall survival rates: 1: RR0. 96? 95 CI: 0. 866? 1. 08? P0. 5055.According to whether the patients with primary hepatocellular carcinoma were treated with TACE after hepatectomy, they were divided into postoperative TACE group and single hepatectomy group. The comparison between the two groups included 14 cases of RCT1 and 14 articles of case-control study. A total of 2184 patients (1097 cases of TACE group after hepatectomy and operation) were included in the study. The results showed that TACE could improve the 1-year overall survival rate of patients with primary hepatocellular carcinoma (HCC) after operation. The results showed that the 1-year overall survival rate of patients with primary hepatocellular carcinoma (HCC) was improved (1: 1. 13% 95% CI: 1.03% 1.24% P0.010%). This study was based on the clinical data of patients with HCC. Tumor diameter > 5 cm, multiple nodules; Subgroup analysis of vascular invasion, The results showed that TACE therapy after operation had important value in the subgroup with the above condition (subgroup analysis of non-risk factor group: RRN 1.1095 CI: 0.97: 1.25% P0. 140; with risk factors group 1. 1695 CI: 1.02n 1.32P0.0288.Compared with the 3-year overall survival rate, TACE treatment could significantly improve the primary survival rate. The 3-year overall survival rate of hepatocellular carcinoma (HCC) patients was 1.33 95% (CI: 1.15) 1.53% (P < 0.000). There was no significant effect of TACE treatment on the 5-year overall survival rate of patients with primary hepatocellular carcinoma after operation (comparison of 5-year overall survival rate: RRRN 1.21% 95: CI0.951.15P0. 1240.Conclusion: P < 0.05). Preoperative TACE treatment in patients with HCC did not shorten the operative time. Reducing the amount of intraoperative bleeding and prolonging the hospital stay did not significantly improve the long-term survival rate of patients with HCC. The 1-year and 3-year survival rates of patients with hepatocellular carcinoma were improved by TACE treatment. The diameter of the tumors in patients with HCC was more than 5 cm and the number of nodules was more than 5 cm. TACE can be used as a routine method for the treatment of vascular invasion.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R735.7

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