Objective To evaluate the clinical effectiveness and safety of transcatheter arterial chemoembolization (TACE) combined with argon-helium cryotherapy system (AHCS) for primary hepatic carcinomas (PHC), and to provide references for clinical practice and research. Methods Such databases as The Cochrane Library, PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data were searched, and other sources like the relavant references were also retrieved to collect the randomized controlled trials (RCTs) about TACE combiend with AHCS for PHC published by May 1st, 2012. After literature screening, data extraction and quality evaluation performed by two reviewers independently according to the inclusion criteria, the meta-analysis was conducted using RevMan 5.1 software. Results A total of 16 RCTs involving 1 467 patients were included. The results of meta-analysis showed: a) The TACE+AHCS group was superior to the TACE alone group in total effective rate, complete necrosis rate, 0.5-, 1-, 1.5-, 2- and 2.5-year survival rates, AFP, CD4 and Th/Ts cells, and there were significant differences (Plt;0.05); and b) The TACE+AHCS group was superior to the AHCS alone group in 0.5-, 1.5-, 2- and 2.5-year survival rates, AFP and Th/Ts cells, and there were significant differences (Plt;0.05). Conclusion Compared with the TACE or AHCS alone, TACE combined with AHCS can improve long-term survival rate and short-term curative effect, and improve PHC patients’ immunity. However, its long-term curative effect and safety still needs to be further verified by more large sample and high quality RCTs.
Objective To systematically evaluate the effectiveness and safety of laparoscopic hepatectomy (LH) versus open hepatectomy (OH) for hepatocellular carcinoma (HCC). Methods Databases including PubMed, EMbase, MEDLINE, SCI, CNKI, CBM, WanFang Data and The Cochrane Library (Issue 3, 2012) were searched to collect the randomized controlled trails (RCTs) and non-RCTs about LH versus OH for HCC. The retrieval time was from inception to August 2012. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. Then the meta-analysis was conducted using RevMan 5.1 software. Results A total of 13 non-RCTs involving 701 patients were included. The results of meta-analysis showed that: Compared with OH, LH had lesser amount of intraoperative bleeding (MD=?144.09, 95%CI ?194.25 to ?93.94, Plt;0.000 01), shorter hospital stay (MD=?5.48, 95%CI ?7.10 to ?3.85, Plt;0.000 01), and lower postoperative complications (OR=0.43, 95%CI 0.27 to 0.66, P=0.000 1). But there were no differences between the 2 groups in operation time (MD=?0.64, 95%CI ?22.95 to 21.68, P=0.96), perioperative death rate, 3-5 year survival rate, and tumor free survival rate. Conclusion LH is superior to OH in treating HCC for it is associated with smaller wound, lesser operative blood loss, shorter hospital stay, and lower postoperative complications. And it is similar as OH in operation time, perioperative death rate and 3-5 year survival rate. So LH is safe and feasible for treating HCC when its indications are strictly controlled. However, for the quantity and quality limitation of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for HCC patients according to an integrative disease assessment.
Objective To systematically review the effectiveness and safety of implanting sustained-release 5-fluorouracil during hepatectomy in patients with primary liver cancer (PLC). Methods We electronically searched the following databases including CENTRAL, MEDLINE, EMbase, WanFang Data, CBM, CNKI and VIP to collect randomized controlled trials (RCTs) on the effectiveness and safety of implanting sustained-release 5-fluorouracil during hepatectomy vs. hepatectomy alone for PLC from inception to October, 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.0 software. Results A total of 6 RCTs involving 951 patients were included. The results of meta-analysis showed that, implanting sustained-release 5-fluorouracil during hepatectomy significantly decreased the total recurrence rates of 1-year and 3-year (1 year: RR=0.48, 95%CI 0.36 to 0.65, Plt;0.000 01; 3 years: RR=0.69, 95%CI 0.50 to 0.96, P=0.03). However, the two groups were alike in decreasing the surem levels of AFP. Besides, the commonly-seen adverse reaction of implanting sustained-release 5-fluorouracil during hepatectomy included abdominal pain and bile leakage. Conclusion Implanting sustained-release 5-fluorouracil during hepatectomy can decrease the 1-year and 3-year recurrence rates of PLC patients, especially for HCC at the early stage. But this conclusion should be interpreted with caution and needs more strictly-designed RCTs with large sample size and enough long follow-up to verify.
Objective To evaluate the efficiency and safety of laparoscopic hepatectomy (LH) and conventional open hepatectomy (OH) in patients with hepatocellular carcinoma (HCC). Methods We searched The Cochrane Library, MEDLINE (1966~2008.3), EMBASE (1966~2008.3), CBM (1979~2008.3), we also handsearched some Chinese journals. Using a defined search strategy, randomized controlled trails and controlled clinical trials of comparing OH with LH for hepatocellular carcinoma were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trails was evaluated by Deeks JJ’s evaluation criterion. Meta–analysis was done using the Cochrane collaboration’s Revman 4.2.10. Results Seven controlled clinical trials (309 patients) were included, The meta–analysis showed that: (1) Four studies (n=198) reported mortality, the mortality rate of the LH group was not significantly different from that of the OH group [OR=1.14, 95%Cl (0.15, 8.65), P=0.90]; (2) Two studies (n=91) reported blood transfusion. There were no significant differences between the two treatment groups in terms of the blood transfusion [OR=0.20, 95%Cl (0.03, 1.19), P=0.08]; (3) Four studies (n=165) reported operation time. There were significant differences in operating time between the two groups [SMD=1.05, 95%CI (0.72, 1.38), Plt;0.000 01]; (4) Four studies (n=165) reported intraoperative blood loss. There were significant differences in intraoperative blood loss between the two groups [SMD= – 1.56, 95%Cl (– 2.39, – 0.73), P=0.000 2]; (5) Five studies (n=210) reported the duration of hospital stay. There were significant differences in duration of hospital stay between the two groups [WMD= – 3.89, 95%CI (– 5.54, – 2.23), Plt;0.000 01]; (6) Two studies (n=248) reported complications. There were significant differences in complications between the two groups [OR=0.31, 95%Cl (0.13, 0.72), P=0.006]; (7) Two studies (n=97) reported ALT. There were significant differences in ALT between the two groups [SMD= – 1.54, 95%Cl (– 207, – 1.01), Plt;0.000 01]. Conclusion LH is associated with less postoperative complications, operative blood loss, duration of hospital stay and lower ALT, but longer operation time. However, the trails available for this systematic review are limited, so a prospective randomized controlled trial is warranted to fully investigate these and other outcome measures.
Objective To evaluate the effectiveness and safety of traditional Chinese medicine (TCM) plus transcatheter arterial chemoembolization (TACE) compared with TACE alone, in the treatment of unresectable hepatocellular carcinoma (HCC). Methods The Cochrane Library, MEDLINE, EMBASE, CANCERLIT, CBM, CNKI and VIP were searched electronically. Relevant journals and conference proceedings were also handsearched. The quality of included studies was assessed according to the criteria recommended by the Cochrane Handbook for Systematic Reviews of Interventions, and meta-analyses were performed for homogeneous studies using The Cochrane Collaboration’s RevMan 4.2.10 software. Subgroup analyses by frequency of TACE (lt;3 or ≥3 times) were also performed. Results Thirty seven trials, all published in China, involving 2 653 participants were included. The quality of 2 studies was graded B (medium) and that of the other 35 was graded C (low). Meta-analyses showed that TCM plus TACE, compared with TACE alone, could significantly improve survival, tumor response (complete and partial), quality of life and clinical symptoms, and was also associated with a lower incidence of adverse reactions. Subgroup analyses indicated that, patients with less than three TACE had more significant improvement in survival and clinical symptoms, while patients with three or more TACE had more significant improvement in tumor response and quality of life. The incidence of adverse reactions was similar between these two different frequencies of TACE. Conclusions The treatment regimen of TCM plus TACE is superior to TACE alone in patients with unresectable HCC. As the existing data have a high risk of bias, the current evidence is insufficient to define the efficacy of the combination treatment, and further large-scale, high-quality randomized controlled trials are needed.
目的 评价选择性介入治疗在原发性肝癌（HCC）门脉高压症中的应用价值。 方法 2008年11月－2011年3月，收治65例临床明确诊断的HCC伴门脉高压症患者，选择性使用肝动脉化学疗法（化疗）栓塞术、脾栓塞术、门静脉化疗栓塞术、门静脉支架、胃冠状静脉栓塞术等介入术式，术后通过观察临床指标、定期复查影像检查等了解病变转归，随访生存期并评价疗效。 结果 65例HCC患者均合并不同程度门静脉高压，其中门静脉癌栓46例中有37例显示肝动脉-门静脉分流，通过肝动脉及门静脉化疗栓塞术进行主瘤体及癌栓治疗。11例行门静脉支架置入术，支架置入后门静脉压较术前明显下降（P＜0.01），支架中位通畅时间为5.8个月。39例行胃冠状静脉和（或）胃短静脉栓塞术，术后有4例再次发生门脉高压性出血，再出血率10.26%。18例行脾动脉栓塞术，术后3个月血小板较术前显著升高（P＜0.01）。随访术后3、6、12及24个月的生存率分别为90.77%、69.23%、35.38%及13.85%。 结论 选择性联合使用各种介入术式是治疗HCC及其相关性门脉高压症的一种有效方法，可有效预防高危风险，延长患者生存期。
摘要:目的： 探讨肝癌患者行射频消融术围手术期的肝功能变化情况,以及相应的护理措施。方法:对2006～2009年6月在我院接受射频消融术治疗的91例肝癌患者,监测其围手术期的肝功能指标,如丙氨酸氨基转移酶及总胆红素等变化情况,分析射频消融术对肝功能的影响,总结相应的护理措施。 结果:全组无死亡病例。射频消融术后早期丙氨酸氨基转移酶及总胆红素与术前有显著差异（P＜005）。结论: 肝癌患者行射频消融术后早期肝功能减退,应加强护理措施,促进患者恢复。 Abstract: Objective: To explore the influence of radiofrequency ablation (RFA) on hepatic function of patients suffering hepatocelluler carcinoma and to summarize corresponding nursing measures.Methods: Ninetyone patients suffering hepatocelluler carcinoma received RFA were studied with their hepatic function preoperation and postoperation. Alanine aminotransferase (ALT) and total bilirubin (TB) were selected as the liver functional parameters,and perioperative changes of the two parameters were measured. Influence of RFA on hepatic function was analyzed and corresponding nursing measures were summarized. Results: Significant changes of ALT and TB were observed early after RFA,and there were statistical difference between preoperation and postoperation (P＜005). Conclusion: Proper nursing measures should be applied to improve hypohepatia and promote recovery of patients.
目的:探讨西南地区雌激素受体α（estrogen receptor α，ERα）基因多态性与原性肝癌关系。方法:选择西南地区100名原发性肝癌患者为实验组，100名非肝病人群作为对照组。应用分子生物学的方法分析PvuⅡ，XbaⅠ限制性片段长度多态性（restriction fragment length polymorphism，RFLP）。同时对人雌激素受体基因上游的短串联重复序列（short tandem repeat，STR）进行纯化、克隆和序列分析，观察ERα基因多态性基因型在实验组与对照组中的基因型分布。结果:PvuⅡ和XbaⅠ限制性片段长度多态性在两组中均呈多态性分布。病例组TA13等位基因频率高于对照组，差异有显著性，TA15等位基因频率低于对照组，差异有显著性。结论:ERα基因多态性与原性肝癌有关，X等位基因可能是其危险因素，P等位基因可能是其保护因素，TA13等位基因可能是其危险因素，TA15等位基因可能是其保护因素。
目的：探讨Na+，K+-ATP1b1（ATP1b1）对肝癌细胞生长及侵袭能力的影响。方法：将ATP1b1表达质粒ATP1b1-CMV-FLAG转染肝癌细胞SMMC-7721，以空质粒转染作对照，通过RT-PCR测定ATP1b1的mRNA表达，在光镜下观察细胞形态学变化，MTT法检测细胞生长增殖，Transwell细胞侵袭实验分析肝癌细胞的侵袭能力。结果：ATP1b1-CMV-FLAG转染后，SMMC-7721的ATP1b1 mRNA表达水平明显增高（P＜0.05）,转染ATP1b1-CMV-FLAG组、pFLAG-CMV-1组和脂质体组的ATP1b1 mRNA表达水平分别为1.159、0.182和0.093;转染ATP1b1-CMV-FLAG的SMMC-7721细胞呈变性改变，其生长受到抑制，转染相同DNA浓度的ATP1b1-CMV-FLAG组与pFLAG-CMV-1组对细胞生长的抑制效应有显著性差异（P＜0.05）；Transwell细胞侵袭实验显示转染ATP1b1-CMV-FLAG组的SMMC-7721细胞的体外侵袭力明显受抑制（P＜0.01）。结论：实验结果说明了促进ATP1b1表达能抑制肝癌细胞的生长及侵袭行为。