摘要
目的 系统评价光动力疗法(photodynamictherapy,PDT)姑息治疗不可切除胆管癌的有效性和安全性。方法 计算机检索Cochrane图书馆CENTRAL2006年第4期、MEDLINE(1966~2007.2)、CNKI(1994~2007.2)和VIP(1989~2007.2)按Cochrane系统评价方法评价纳入研究质量,并进行描述性分析。结果共纳入两个随机对照试验(RCT),包括71例患者。结果 显示,两个RCT的PDT+支架组中位生存时间均远长于单用内置支架组,其差异有统计学意义(P〈0.01)1个RCT显示,PDT组总体生存质量明显优于单用支架组,两组差值25.4(14.4~36.3);1个RCT显示,两组Karnofsky指数均无改变。未发现PDT有任何严重副作用。结论 现有证据表明,光动力治疗不可切除胆管癌可延长患者生存时间,降低治疗负担,但可能增加胆道感染率;对于后者,可用抗菌治疗加以控制,余无其他严重副作用,施术者内镜技术熟练即可实施此疗法。鉴于本系统评价仅纳入两个RCT,且例数较少,因此所得结果尚需更多大样本RCT加以验证。
Objective To assess the effectiveness and safety of photodynamictherapy (PDT) for patients with nonresectable bile duct cancer. Methods Two reviewers independently searched The Cochrane Library (issue 4, 2006), MEDLINE (1966 to February 2007), CNKI (1994 to February 2007) and VIP(1989 to February 2007), respectively. The quality of included studies was assessed according to the guidance in the Cochrane Handbook of Systematic Reviews of Interventions. Results Two randomized controlled trials involving 71 patients with nonresectable bile duct cancer met the inclusion criteria and were included. Both of these trials reported that the median survival time in patients who were treated with endoprostheses and PDT was longer than for those treated with endoprostheses alone (493 days versus 98 days, and 21 months versus 7 months, in the two trials respectively).One trial reported that the global quality of life in patients in the PDT with endoprostheses group was significantly better than that for the endoprostheses alone group: the difference of Karnofshy index between the two groups was 25.4 (14.4-36.3). The other trial reported no difference between the two groups. No severe adverse effects were observed during either trial. Conclusion Current evidence demonstrates that PDT can improve the survival time of patients with nonresectable bile duct cancer, and reduce the burden of treatment. The treatment might increase biliary infectious rate, but this can be managed by antibiotics therapy. No severe adverse effects are observed. More randomized controlled trials, withlarge sample sizes, may lead to more accurate results.
出处
《中国循证医学杂志》
CSCD
2007年第6期456-460,共5页
Chinese Journal of Evidence-based Medicine
关键词
光动力疗法
不可切除胆管癌
疗效
系统评价
Photodynamictherapy
Nonresectable bile duct cancer
Effect
Systematic review