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目的系统评价TACE联合PSE治疗原发性肝癌伴脾功能亢进患者的疗效及安全性。方法计算机检索The Cochrane Library(2015年11期)、PubMed、EMbase、CBM、VIP、CNKI和WanFang Data数据库,检索时限均从建库至2015年11月,搜集TACE联合PSE治疗原发性肝癌的相关随机对照试验(RCT)。由2名评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入11个RCT,包括708例患者。Meta分析结果显示:TACE联合PSE较单纯TACE能明显提升晚期HCC合并脾亢患者术后4周CD4计数[MD=6.99,95%CI(4.60,9.38),P<0.000 01]、CD4/CD8比值[MD=0.64,95%(0.45,0.84),P<0.000 01]和半年生存率[RR=1.16,95%CI(1.02,1.32),P=0.02],降低自发性腹膜炎[RR=0.20,95%CI(0.05,0.84),P=0.03]和食道胃底静脉破裂出血的发生率[RR=0.17,95%CI(0.04,0.68),P=0.01]。两组术后栓塞综合征发生率相当[RR=1.17,95%CI(0.79,1.75),P=0.44]。结论在不能手术切除的中晚期原发性肝癌合并脾亢患者中,TACE联合PSE较单纯TACE治疗更安全有效。受纳入的研究数量和质量的限制,上述结论仍有待开展更多高质量研究予以证实。
Objective To evaluate the efficacy and safety of TACE combined with PSE in the treatment of patients with primary hepatocellular carcinoma and hypersplenism. Methods The databases of The Cochrane Library (2015-11), PubMed, EMbase, CBM, VIP, CNKI and WanFang Data were retrieved by computer. The search time was from the database to November 2015, and the correlation between TACE and PSE in the treatment of primary liver cancer Randomized controlled trial (RCT). After two reviewers independently screened the literature, extracted data, and assessed the risk of being included in the study, Meta-analysis was performed using RevMan 5.3 software. Results A total of 11 RCTs were included, including 708 patients. The result of Meta analysis showed that TACE combined with PSE could significantly improve the CD4 count (P <0.000 01), the ratio of CD4 / CD8 RR = 1.16, 95% CI (1.02, 1.32), P = 0.02], and decreased spontaneous peritonitis (RR = 0.20, P = 0.0001) 95% CI (0.05, 0.84), P = 0.03] and incidence of esophageal and gastric venous rupture (RR = 0.17, 95% CI 0.04,0.68, P = 0.01). The incidence of postoperative embolism syndrome was comparable in both groups [RR = 1.17, 95% CI (0.79, 1.75), P = 0.44]. Conclusion TACE combined with PSE is more effective and safe than simple TACE in patients with unresectable primary liver cancer complicated with hypersplenism. Due to the limited number and quality of studies included, the above conclusion remains to be confirmed by more high-quality studies.