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中华介入放射学电子杂志 ›› 2018, Vol. 06 ›› Issue (01) : 75 -80. doi: 10.3877/cma.j.issn.2095-5782.2018.01.017

所属专题: 文献

循证医学

外科手术对比经肝动脉栓塞治疗肝血管瘤的Meta分析
咸玉涛1, 陈奇峰1,(), 范文龙1, 杨正强1, 施海彬1   
  1. 1. 210000 南京,南京医科大学第一附属医院介入放射科
  • 收稿日期:2017-06-13 出版日期:2018-02-01
  • 通信作者: 陈奇峰

Meta-analysis of comparison between surgical operation and transarterial embolization in treatment of hepatic hemangioma

Yutao Xian1, Qifeng Chen1,(), Wenlong Fan1, Zhengqiang Yang1, Haibin Shi1   

  1. 1. Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
  • Received:2017-06-13 Published:2018-02-01
  • Corresponding author: Qifeng Chen
  • About author:
    Corresponding author: Chen Qifeng, Email:
引用本文:

咸玉涛, 陈奇峰, 范文龙, 杨正强, 施海彬. 外科手术对比经肝动脉栓塞治疗肝血管瘤的Meta分析[J/OL]. 中华介入放射学电子杂志, 2018, 06(01): 75-80.

Yutao Xian, Qifeng Chen, Wenlong Fan, Zhengqiang Yang, Haibin Shi. Meta-analysis of comparison between surgical operation and transarterial embolization in treatment of hepatic hemangioma[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2018, 06(01): 75-80.

目的:

系统评价外科手术与经肝动脉栓塞术(transarterial embolization,TAE)治疗肝血管瘤的临床效果及并发症情况。

方法:

检索数据库中关于外科手术对比TAE治疗肝血管瘤的临床对照研究文献,检索时限均自建库至2016年11月。2名研究员按照纳入与排除标准独立筛选文献、提取资料并评价质量,采用RevMan 5.3软件作统计学分析。

结果:

最终6篇文献纳入研究,总病例数521例,其中326例接受外科手术治疗,295例接受TAE治疗。Meta分析结果显示:外科手术组复发率低于TAE组(OR=0.02,95%CI:0~0.08,P<0.05);外科手术组平均手术时间长于TAE组(OR=1.25,95%CI:0.88~1.62,P<0.05);外科手术组平均住院时间长于TAE组(OR=1.94,95%CI:1.50~2.39,P<0.05);外科手术组恢复正常工作时间长于TAE组(OR=1.18,95%CI:0.44~1.91,P=0.002);外科手术组平均住院费用(OR=0.25,95%CI:-1.04~1.53,P=0.71)和术后并发症发生率(OR=3.42,95%CI:0.96~12.25,P=0.06)与TAE组无明显差异。

结论:

外科手术和TAE均是治疗肝血管瘤的安全有效方式。外科手术治疗肝血管瘤复发率低,但手术时间、住院时间及恢复正常工作时间较长,两种治疗方式的近期并发症与治疗费用无显著差别。因此治疗方案的选择要结合上述因素综合考量。

Objective:

To systematically evaluate and compare the surgical operation and transarterial embolization (TAE) in the treatment of hepatic hemangioma.

Methods:

The trials concerning surgical operation and TAE treatment for hepatic hemangioma were searched from database, including PubMed, Embase, Cochrane, China National Knowledge Internet (CNKI) and Wanfang Data. The retrieval time was from the establishment of database to November 2016, and the references in the literature were traced back. According to the inclusion and exclusion criteria, the selected scientific studies were separately screened by two researchers. The data were extracted and evaluated. RevMan 5.3 software was used to make statistical analysis.

Results:

Six studies were identified as eligible for inclusion in this analysis and included 521 patients with 326 treated with surgical operation and 295 with TAE. Our data analysis indicated that the recurrence rates (OR=0.02, 95%CI: 0.00-0.08, P<0.05) in surgical operation group were significantly lower than those in TAE group. Surgical operation group had significantly longer mean operation lasting time (OR=1.25, 95%CI: 0.88-1.62, P<0.05) , hospitalization (OR=1.94, 95%CI: 1.50-2.39, P<0.05) and recovery time (OR=1.18, 95%CI: 0.44-1.91, P=0.002) than those in TAE group. Besides, overall cost (OR=0.25, 95%CI: -1.04-1.53, P=0.71) and post-procedure complications rates (OR=3.42, 95%CI: 0.96-12.25, P=0.06) had no significant difference between two groups.

Conclusions:

Both surgical operation and TAE are safe and effective in the treatment of hepatic hemangioma. Surgical operation was superior to TAE in terms of tumor recurrence. However, surgical operation had longer operation lasting time, hospitalization and recovery time, and there was no significant difference in the cost and post-procedure complications rates between two treatments. As a result, the treatment strategy should be determined based on the factors referred above.

图1 文献筛选流程及结果
表1 纳入研究的质量评价
图2 外科手术与TAE治疗肝血管瘤患者复发率比较
图3 外科手术与TAE治疗肝血管瘤患者的平均手术时间比较
图4 外科手术与TAE治疗肝血管瘤患者的平均住院时间比较
图5 外科手术与TAE治疗肝血管瘤患者恢复正常工作时间比较
图6 外科手术与TAE治疗肝血管瘤患者的平均住院费用比较
图7 外科手术与TAE治疗肝血管瘤患者的近期并发症比较
[1]
Brouwers MA, Peeters PM, de Jong KP, et al. Surgical treatment of giant haemangioma of the liver[J]. Br J Surg,1997,84(3):314-316.
[2]
Mortele KJ, Ros PR. Benign liver neoplasms[J]. Clin Liver Dis,2002,6(1):119-145.doi:10.1016/S1089-3261(03)00069-2.
[3]
Kim YI, Hwang YJ, Lee JW, et al. 101 hepatectomies under continuous inflow occlusion following simple in-situ liver cooling in patients with chronic liver diseases[J]. Hepatogastroenterology, 2004, 51(58):1093-1098.
[4]
Bajenaru N, Balaban V, Săvulescu F, et al. Hepatic hemangioma-review[J]. J Med Life, 2015, 8 Spec Issue:4-11.
[5]
Nichols FC, van Heerden JA, Weiland LH. Benign liver tumors[J]. Surg Clin North Am, 1989, 69(2):297-314.
[6]
van Rosmalen BV, Bieze M, Besselink MG, et al. Long-term outcomes of resection in patients with symptomatic benign liver tumours[J]. HPB(Oxford), 2016, 18(11):908-914. doi: 10.1016/j.hpb.2016.07.013.
[7]
Yamamoto T, Kawarada Y, Yano T, et al. Spontaneous rupture of hemangioma of the liver: treatment with transcatheter hepatic arterial embolization[J]. Am J Gastroenterol, 1991, 86(11):1645-1649.
[8]
Sun JH, Nie CH, Zhang YL, et al. Transcatheter arterial embolization alone for giant hepatic hemangioma[J]. PLoS One, 2015, 10:e0135158.
[9]
张宗利,黄建成,王庆良,等.152例肝血管瘤的临床治疗分析[J].中国现代普通外科进展,2011,1(4):281-285. doi:10.3969/j.issn.1009-9905.2011.04.011.
[10]
范才军,何建峰,唐勇.外科手术与TAE治疗肝血管瘤临床前瞻性研究[J].重庆医学,2008,37(15):1663-1664.doi:10.3969/j.issn.1671-8348.2008.15.009.
[11]
朱荣华,胡刚峰,王华,等.外科手术与经导管动脉栓塞法治疗肝血管瘤疗效比较[J].现代仪器与医疗,2016,22(5):9-11. doi:10.11876/mimt201605004.
[12]
张小昭,王彦超,连文波,等.外科手术与肝动脉介入栓塞治疗肝血管瘤临床分析[J].中华实用诊断与治疗杂志,2015,29(9):875-876. doi:10.13507/j.issn.1674-3474.2015.09.015.
[13]
曾庆乐,陈勇,赵剑波,等.介入与外科手术治疗症状性肝海绵状血管瘤的成本效益分析[J].介入放射学杂志,2009,18(2):93-96.doi:10.3969/j.issn.1008-794X.2009.02.005.
[14]
刘志华,吴瑞,徐国华.放射介入治疗肝海绵状血管瘤临床疗效评价[J].中国当代医药,2012,19(11):89-90. doi:10.3969/j.issn.1674-4721.2012.11.049.
[15]
Wang Y, Ji W, Zhang X, et al. Laparoscopic liver resection and enucleation of liver hemangioma with selective hepatic vascular occlusion: technique and indications[J]. J Laparoendosc Adv Surg Tech A, 2017, 27(9):944-950.
[16]
Cheng WL, Qi YQ, Wang B, et al. Enucleation versus hepatectomy for giant hepatic haemangiomas: a meta-analysis[J]. Ann R Coll Surg Engl, 2017, 99(3):237-241. doi:10.1308/rcsann.2016.0349.
[17]
Feng X, Hu Y, Peng J, et al. A left-sided approach for resection of hepatic caudate lobe hemangioma:two case reports and a literature review[J]. Int Surg, 2015, 100(6):1054-1059. doi:10.9738/INTSURG-D-14-00317.1.
[18]
Toro A, Mahfouz AE, Ardiri A, et al. What is changing in indications and treatment of hepatic hemangiomas. A review[J]. Ann Hepatol, 2014, 13(4):327-339.
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