經皮無水酒精治療直徑≤3cm肝癌的系統評價_《中國循證醫學雜志》

作者：

張金輝 ¹ , 阿依甫汗阿汗 ¹ , 張日新 ² , 曹峻 ¹ , 謝飛 ¹ , 孫玉亮 ³ ,  邰沁文 ¹

1. 新疆醫科大學第一附屬醫院肝（移植）腔鏡外科（烏魯木齊?830054）；2. 武漢市中心醫院普外科（武漢?430010 ）；3. 新疆醫科大學第一附屬醫院口腔科（烏魯木齊?830054）;

關鍵詞：

經皮無水酒精肝癌療效安全性系統評價

DOI：

10.7507/1672-2531.20090123

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目的　系統評價經皮無水酒精（PEI）治療直徑≤3 cm肝癌的療效和安全性。
方法　計算機檢索Cochrane 圖書館臨床對照試驗數據庫（2008 年第2 期）、PubMed（1978 ～ 2008）、EMbase（1966 ～ 2008）、Ovid（2000 ～ 2008）、中國生物醫學文獻數據庫（1978 ～ 2008）和中國期刊全文數據庫（1979 ～ 2008），手工檢索中、英文已發表和未發表的資料以及查閱文后參考文獻，文獻檢索無語種限制。按Cochrane 系統評價方法篩選試驗、評價納入研究的方法學質量、提取資料，并用RevMan 4.2.10版軟件進行Meta分析。
結果　本系統評價納共入7個隨機對照試驗，包括891例患者。按測量指標和干預措施進行亞組分析。結果顯示，直徑≤3 cm肝癌治療后1、3年生存率與局部復發率，PEI與經皮射頻消融（RFA）治療比較差異均有統計學意義［RR=0.95，95%CI（0.91，1.00）；RR=0.80，95%CI（0.71，0.91）；RR=2.18，95%CI（1.11，4.30）；RR=2.59，95%CI（1.55，4.32）］；PEI與經RFA治療比較，直徑2～3 cm的肝癌治療后3年無瘤生存率差異有統計學意義［RR=0.47，95%CI（0.24，0.93）］；兩種治療方式在其余指標方面的差異均無統計學意義。
結論　現有有限證據表明，對于直徑≤3 cm的肝癌，PEI與經皮醋酸注射（PAI）治療、手術切除的療效相當；PEI注射+RFA與RFA治療的療效無差異；治療直徑≤2 cm肝癌，PEI的療效與RFA無差別，但RFA治療直徑2～3 cm肝癌的療效優于PEI。由于本系統評價納入RCT數量及樣本量較少，質量偏低，一些主要測量指標報道過少，缺乏足夠信息進行分析，尚需開展更多更高質量RCT進一步驗證其療效和安全性。

引用本文： 張金輝,阿依甫汗阿汗,張日新,曹峻,謝飛,孫玉亮,邰沁文. 經皮無水酒精治療直徑≤3cm肝癌的系統評價. 中國循證醫學雜志, 2009, 09(6): 695-704. doi: 10.7507/1672-2531.20090123 復制

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6.	Liao CS, Yang KC, Yen AM, et al. Remission, relapse, and metastasis/death of small hepatocellular carcinoma treated with percutaneous ethanol injection. Cancer J, 2006, 12(3): 175-177.
7.	Livraghi T, Giorgio A, Marin G, et al. Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology, 1995, 197(1): 101-108.
8.	Gournay J, Tchuenbou J, Richou C, et al. Percutaneous ethanol injection vs. resection in patients with small single hepatocellular carcinoma: A retrospective case-control study with cost analysis. Aliment Pharmacol Ther, 2002, 16(8): 1529-1538.
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11.	Lin SM, Lin CJ, Lin CC, et al. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma <or=4cm . Gastroenterology, 2004, 127(6): 1714-1723.
12.	Shiina S, Teratant T, Obi S, et al. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology, 2005, 129(1): 122-130.
13.	Brunell F, Veltri A, Carucctr P, et al. Adiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: A randomized controlled trial. Scandinavian Journal of Gastroenterology, 2008, 43(6): 727-735.
14.	Lin SM, Lin CJ, Lin CC, et al. Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut, 2005, 54: 1151-1156.
15.	Ohnishi K, Yoshioka H, Ito S, et al. Prospective randomized controlled trial comparing percutaneous acetic acid injection and percutaneous ethanol injection for small hepatocellular carcinoma. Hepaology, 1998, 27(1): 67-72.
16.	Huang GT, Lee PH, Tsang YM, et al. Percutaneous ethanol injection versus surgical resection for the treatment of small hepatocellular carcinoma. Ann Surg, 2005, 242(1): 36-42.
17.	Zhang YJ, Liang HH, Chen MS, et al. Hepatocellular carcinoma treated with radiofrequency ablation with or without ethanol injection: A Prospective Randomized Trial. Radiology, 2007, 244: 599-607.
18.	陳敏山, 張耀軍, 李錦清, 等. 經皮射頻消融聯合瘤內無水酒精注射與單純射頻消融治療小肝癌的療效比較. 中國腫瘤雜志, 2005, 10: 623-625.
19.	Lencioni RA, Allgaier HP, Cioni D, et al. Small hepatocellular carcinoma in cirrhosis:Randomized comparison of radiofrequency thermal ablation versus percutaneous ethanol injection. Radiology, 2003, 228(1): 235-240.
20.	Kurokohchi K, Watanabe S, Masaki T, et al. Combined use of percutaneous ethanol injection and radiofrequency ablation for the effective treatment of hepatocelluar carcinoma. Int J Oncol, 2002, 21(4): 841-846.
21.	Moher D, Sc M. The CONSORT Guidelines: improving the quality of research. Consolidated standards of reporting trials. Interview by Bonnie Horrigan. Altern Ther Health Med, 2002, 8(3): 103-108.

1. Jemal A, Murray T, Ward E, et al. Cancer statistics. CA Cancer J Clin, 2005, 55(1): 10-30.
2. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology, 2005, 42(5): 1208-1236.
3. Sigura N, Takara K, Ohto M, et al. Percutaneous intratumoral injection of ethanol under ultrasound imaging for treatment of small hepatocellular carcinoma. Acta Hepatol Jpn, 1983, 24: 920-925.
4. Nimmaanrat S, Prechawai C, Tanomkiat W. Anesthetic techniques and complications in patients with hepatocellular carcinoma undergoing percutaneous ethanol injection. Minerva Anestesiol, 2007, 73(6): 333-337.
5. Castroagudín JF, Delgado M, Villanueva A, et al. Safety of percutaneous ethanol injection as neoadjuvant therapy for hepatocellular carcinoma in waiting list liver transplant candidates. Transplant Proc, 2005, 37(9): 3871-3873.
6. Liao CS, Yang KC, Yen AM, et al. Remission, relapse, and metastasis/death of small hepatocellular carcinoma treated with percutaneous ethanol injection. Cancer J, 2006, 12(3): 175-177.
7. Livraghi T, Giorgio A, Marin G, et al. Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology, 1995, 197(1): 101-108.
8. Gournay J, Tchuenbou J, Richou C, et al. Percutaneous ethanol injection vs. resection in patients with small single hepatocellular carcinoma: A retrospective case-control study with cost analysis. Aliment Pharmacol Ther, 2002, 16(8): 1529-1538.
9. Daniele B, De Sio I, Izzo F, et al. Hepatic resection and percutaneous ethanol injection as treatments of small hepatocellular carcinoma: a Cancer of the Liver Italian Program (CLIP 08) retrospective case-control study. J Clin Gastroenterol, 2003, 36(1): 63-67.
10. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Review of Interventions 4.2.6 [Updated September 2006]. The Cohrane Library, Issue 4, 2006. Chichester, UK: JohnWiley & Sons.Ltd.
11. Lin SM, Lin CJ, Lin CC, et al. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma <or=4cm . Gastroenterology, 2004, 127(6): 1714-1723.
12. Shiina S, Teratant T, Obi S, et al. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology, 2005, 129(1): 122-130.
13. Brunell F, Veltri A, Carucctr P, et al. Adiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: A randomized controlled trial. Scandinavian Journal of Gastroenterology, 2008, 43(6): 727-735.
14. Lin SM, Lin CJ, Lin CC, et al. Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut, 2005, 54: 1151-1156.
15. Ohnishi K, Yoshioka H, Ito S, et al. Prospective randomized controlled trial comparing percutaneous acetic acid injection and percutaneous ethanol injection for small hepatocellular carcinoma. Hepaology, 1998, 27(1): 67-72.
16. Huang GT, Lee PH, Tsang YM, et al. Percutaneous ethanol injection versus surgical resection for the treatment of small hepatocellular carcinoma. Ann Surg, 2005, 242(1): 36-42.
17. Zhang YJ, Liang HH, Chen MS, et al. Hepatocellular carcinoma treated with radiofrequency ablation with or without ethanol injection: A Prospective Randomized Trial. Radiology, 2007, 244: 599-607.
18. 陳敏山, 張耀軍, 李錦清, 等. 經皮射頻消融聯合瘤內無水酒精注射與單純射頻消融治療小肝癌的療效比較. 中國腫瘤雜志, 2005, 10: 623-625.
19. Lencioni RA, Allgaier HP, Cioni D, et al. Small hepatocellular carcinoma in cirrhosis:Randomized comparison of radiofrequency thermal ablation versus percutaneous ethanol injection. Radiology, 2003, 228(1): 235-240.
20. Kurokohchi K, Watanabe S, Masaki T, et al. Combined use of percutaneous ethanol injection and radiofrequency ablation for the effective treatment of hepatocelluar carcinoma. Int J Oncol, 2002, 21(4): 841-846.
21. Moher D, Sc M. The CONSORT Guidelines: improving the quality of research. Consolidated standards of reporting trials. Interview by Bonnie Horrigan. Altern Ther Health Med, 2002, 8(3): 103-108.

《中國循證醫學雜志》

經皮無水酒精治療直徑≤3cm肝癌的系統評價

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經皮無水酒精治療直徑≤3cm肝癌的系統評價

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