射频消融对比手术切除治疗孤立性结直肠癌肝转移肿瘤的-影像技术.DOCVIP

射频消融对比手术切除治疗孤立性结直肠癌肝转移肿瘤的Meta分析 许浩，王家胜，杨恒，刘洋，杨强（重庆医科大学附属永川医院普通外科，重庆402160）摘要目的：比较射频消融（RFA）和手术切除对孤立性结直肠癌肝转移的疗效。方法：计算机检索国内外多个数据库，收集RFA和手术切除治疗孤立性结直肠癌肝转移的临床对照试验，按Cochrane系统评价方法对纳入研究的质量进行评价，用RevMan5.0软件对资料进行Meta分析。结果：最终纳入9个研究，共1259例患者，其中RFA440例，手术切除819例。Meta分析结果显示，RFA患者较手术切除患者5年生存率明显降低（P=0.02），术后总体复发率（P=0.01）和局部复发率均明显增高（P=0.003）；两者在治疗直径3cm的肿瘤上术后5年生存率无明显差异（P=0.43）。结论：手术切除治疗孤立性结直肠癌肝转移疗效优于RFA，但肿瘤直径3cm时，可考虑采用RFA。 Radiofrequencyablationversushepaticresectionforsolitarycolorectallivermetastasis:aMeta-analysisXUHao,WANGJiasheng,YANGHeng,LIUYang,YANGQiang(DepartmentofGeneralSurgery,YongchuanHospital,ChongqingMedicalUniversity,Chongqing402160,China)ABSTRACTObjective:Tocomparethetherapeuticefficaciesbetweenradiofrequencyablation(RFA)andhepaticresectionforsolitarycolorectallivermetastasis.Methods:ThecontrolledclinicaltrialsconcerningRFAandhepaticresectionfortreatmentofsolitarycolorectallivermetastasiswerecollectedthroughliteratureretrievalfromseveralnativeandforeignonlinedatabases.ThequalityoftheincludestudieswasassessedaccordingtotheCochranesystematicreviewmethod,anddataanalysiswasconductedbyusingRevMan5.0software.Results:Ninestudieswerefinallyincluded,withatotalof1259patients,ofwhom,440casesunderwentRFAand819casesweresubjectedtosurgicalresection.TheresultsofMeta-analysisdemonstratedthatthe5-yearoverallsurvivalratewaslower,andtheoverallrecurrenceandlocalrecurrenceratewashigherinpatientsundergoingRFAthanthatinpatientsreceivingsurgicalresection(P=0.02,P=0.01,P=0.003);therewasnoobviousdifferencein5-yearoverallsurvivalrateafteroperationbetweenpatientsundergoingRFAandhepaticresectionwhenthetumordiameterwaslessthan3cm(P=0.43).Conclusion:HepaticresectionhasabetterefficacythanthatofRFAforsolitarycolorectallivermetastasis,butRFAcouldbeconsideredwhentumordiameterislessthan3cm. KEYWORDSLiverNeoplasms;ColorectalNeoplasms;Hepatectomy;RadiofrequencyAblation;Meta-AnalysisCLCnumber:R657.3Documentcode:ADOI:10.7659/j.issn.1005-6947.2013.07.004 结直肠癌现位居恶性肿瘤第3位，在全世界每年大约新增100万结直肠癌患者，大约有50%的结直肠癌患