Pan Tianfan, Gao Feng, Huang Xiangzhong, Xu Xinjian
Department of Interventional Radiology, Jiangyin People's Hospital, 3 Ying Rui Road, Jiangyin, 214400, Jiangsu Province, China.
Nanjing Medical University, Nanjing, 211100, Jiangsu Province, China.
Clin Transl Oncol. 2024 Jan;26(1):155-170. doi: 10.1007/s12094-023-03232-3. Epub 2023 Jun 16.
To compare the efficacy and safety between emergency hepatectomy (EH) and emergency transarterial embolization (TAE) followed by staged hepatectomy (SH) in the treatment of spontaneous ruptured hepatocellular carcinoma (rHCC).
Databases (PubMed, EMBASE, Web of science, Cochrane Library, ClinicalTrial.gov, CNKI, Wanfang and VIP) were searched for all relevant comparative studies from January 2000 to October 2020. Odds ratio (OR) and mean difference (MD) with 95% confidence interval (CI) were pooled for dichotomous and continuous variables, respectively. Subgroup analyses based on the kind of embolization were conducted. RevMan 5.3 software was adopted for meta-analysis.
Eighteen studies with 871 patients were finally included in this meta-analysis, 448 in EH group and 423 in TAE + SH group. No significant difference was observed in successful hemostasis (P = 0.42), postoperative hospital stay (P = 0.12), complication rate (P = 0.08) between EH and TAE + SH group. However, TAE + SH group was associated with shorter operating time (P < 0.00001), fewer perioperative blood loss (P = 0.007), fewer blood transfusion (P = 0.003), lower in-hospital mortality (P < 0.00001) and higher 1-year survival as well as 3-year survival (P < 0.0001; P = 0.003) compared with EH group.
Compared with EH, TAE + SH could reduce perioperative operating time, blood loss, blood transfusion, mortality rate and increase the long-term survival rate of the rHCC patients, which may be a better treatment for resectable rHCC.
比较急诊肝切除术（EH）与急诊经动脉栓塞术（TAE）联合分期肝切除术（SH）治疗自发性破裂肝细胞癌（rHCC）的疗效和安全性。
检索数据库（PubMed、EMBASE、Web of science、Cochrane Library、ClinicalTrial.gov、中国知网、万方和维普），查找2000年1月至2020年10月期间所有相关的比较研究。分别对二分类变量和连续变量合并比值比（OR）和均差（MD）及其95%置信区间（CI）。基于栓塞类型进行亚组分析。采用RevMan 5.3软件进行荟萃分析。
本荟萃分析最终纳入18项研究共871例患者，EH组448例，TAE+SH组423例。EH组与TAE+SH组在止血成功率（P=0.42）、术后住院时间（P=0.12）、并发症发生率（P=0.08）方面差异无统计学意义。然而，与EH组相比，TAE+SH组手术时间更短（P<0.00001）、围手术期失血量更少（P=0.007）、输血次数更少（P=0.003）、住院死亡率更低（P<0.00001），1年生存率和3年生存率更高（P<0.0001；P=0.003）。
与EH相比，TAE+SH可减少rHCC患者围手术期手术时间、失血量、输血量、死亡率，并提高长期生存率，可能是可切除rHCC的更好治疗方法。
