摘要
目的系统评价热疗(HT)联合腹腔热灌注化疗(IHPC)与单纯IHPC比较治疗恶性腹水的有效性和安全性。方法计算机检索PubMed、he Cochrane Library、EMbase、VIP、WanFang Data、CNKI和CBM等数据库,全面收集HT联合IHPC与IHPC比较治疗恶性腹水的随机对照试验(RCT),检索时限均为建库至2013年3月,并追溯纳入研究的参考文献。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.1软件进行Meta分析。结果共纳入16个RCT,984例患者。Meta分析结果显示,与单纯IHPC组相比,HT联合IHPC组的腹水控制有效率[OR=3.40,95%CI(2.58,4.48),P<0.000 01]和生活质量改善率[OR=2.77,95%CI(1.90,4.05),P<0.000 01]均优于单纯IHPC组,且差异均有统计学意义;但在1年生存率方面,两组差异无统计学意义[OR=1.80,95%CI(0.61,5.31),P=0.28]。两组在恶心呕吐、腹胀腹痛、骨髓抑制、腹泻及便秘发生率方面,差异均无统计学意义(P>0.05)。结论本系统评价结果显示,与单纯IHPC相比,HT联合IHPC可明显提高恶性腹水患者的治疗有效率和患者的生活质量,且不增加毒副反应,但在1年生存率方面,两组差异无统计学意义。受纳入研究数量与质量限制,本研究结果尚需开展大样本、高质量的RCT进一步验证。
Objective To systematically review the effectiveness and safety of hyperthermia （HT） plus intraperitoneal hyperthermic perfusion chemotherapy （IHPC） versus IHPC alone for malignant ascites.
Methods Such databases as PubMed, The Cochrane Library, EMbase, VIP, WanFang, CNKI and CBM were electronically and comprehensively searched for randomized controlled trials （RCTs） on HT plus IHPC vs. IHPC alone for malignant ascites from inception to March 2013. Two reviewers independently screened studies according to inclusion and exclusion criteria, extracted data and assessed quality of the included studies. References of the included studies were also retrieved. Then, meta-analysis was performed using RevMan 5.1 software.
Results A total of 16 RCTs involving 984 patients were included. The results of meta-analysis showed that, compared with the IHPC alone group, the HT plus IHPC group had a higher effective rate of controlling ascites （OR=3.40, 95%CI 2.58 to 4.48, P〈0.000 01）, better improvement in quality of life （OR=2.77, 95%CI 1.90 to 4.05, P〈0.000 01）, with significant differences. The two groups were alike in 1-year survival with no significant difference （OR=1.80, 95%CI 0.61 to 5.31, P=0.28）. As for safety, there was no significant difference between the two groups in the incidences of nausea and vomiting, abdominal distension and pain, myelosuppression, diarrhea, and constipation.
Conclusion The results of this systematic review show that, compared with IHPC alone, HT plus IHPC improves the effective rate as well as the quality of life of patients with malignant ascites, and it does not increase the incidences of adverse reactions. Due to the limited quality and quantity of the included studies, more high quality RCTs with larger sample size are needed to verify the above conclusion.
出处
《中国循证医学杂志》
CSCD
2013年第10期1244-1250,共7页
Chinese Journal of Evidence-based Medicine
关键词
热疗
腹腔热灌注化疗
恶性腹水
META分析
系统评价
随机对照试验
Hyperthermia
Intraperitoneal hyperthermic perfusion chemotherapy
Malignant ascites
Meta-analysis
Systematic review
Randomized controlled trial
