目的系统性评价肝静脉剥夺术(LVD)与门静脉栓塞(PVE)治疗剩余肝体积(FLR)不足的肝脏恶性肿瘤的效果及预后。方法本研究根据PRISMA指南完成,PROSPERO注册号:CRD42024533292。检索PubMed、Embase、Cochrane Library、Web of Science、知...目的系统性评价肝静脉剥夺术(LVD)与门静脉栓塞(PVE)治疗剩余肝体积(FLR)不足的肝脏恶性肿瘤的效果及预后。方法本研究根据PRISMA指南完成,PROSPERO注册号:CRD42024533292。检索PubMed、Embase、Cochrane Library、Web of Science、知网、万方、维普等数据库中关于LVD与PVE效果比较的所有文献。根据制定的纳入和排除文献标准,筛选相关文献,评估文献质量,提取相关LVD与PVE的临床对比资料,整理并分析数据。使用RevMan 5.3软件进行Meta分析。结果共纳入12篇文献(均为队列研究),含644例患者(LVD组245例,PVE组399例)。Meta分析结果显示,在栓塞后FLR增长率(SMD=0.84,95%CI:0.59~1.09)、栓塞后FLR每日增长体积(SMD=1.19,95%CI:0.64~1.73)、栓塞后并发症发病率(RR=1.59,95%CI:1.06~2.38)、栓塞与二期手术间隔时间(SMD=-0.81,95%CI:-1.32~-0.29)和二期手术完成率(RR=1.09,95%CI:1.01~1.18)两组间差异均有统计学意义(P值均<0.05)。结论LVD相较于PVE能够使患者在相对较短的时间内获得达到手术指征的FLR,从而降低疾病进展的发生率以及解决肥大不足的问题,达到更高的二期手术切除率,从而使更多的肝癌患者受益。并且,LVD在二期手术中具有和PVE相似的安全性。展开更多
Objective: To differentiate diffuse liver cancer from portal cirrhosis by using ultrasonography. Methods: We analyzed the sonographic images of 15 patients with diffuse liver cancer and 30 patients with portal cirrhos...Objective: To differentiate diffuse liver cancer from portal cirrhosis by using ultrasonography. Methods: We analyzed the sonographic images of 15 patients with diffuse liver cancer and 30 patients with portal cirrhosis. Results: The patients with diffuse liver cancer showed enlarged liver and obvious echo of nodules. The rate of portal embolism and swelling of lymph nodes a- round the porta hepatis was high. The patients with portal cirrhosis showed diminished liver and the obvi- ous echo of fiber proliferation. The rates of spleen enlargement and ascites as well as gallbladder edema were high. Conclusions: To identify sonographic characteristics inside and outside of the liver. It is helpful in diffe- rentiating diffuse liver cancer from portal cirrhosis. The sonographic characteristics inside the liver in- clude surface and size, node echo, echo of fibrous tissue hyperplasia. They are difficult to identify when diffuse liver cancer merges with considerable cirrho- sis. The acoustic image characteristics of the two di- seases overlap. Hence attention should be paid to the size of the liver, proliferation of cells of diffuse liver carcinoma. In sonographic characteristics outside the liver, embolism of the portal vein and swelling of lymph nodes in the porta hepatis are particularly use- ful to identify diffuse liver cancer or diffuse liver cancer combined with liver cirrhosis in particular.展开更多
文摘目的系统性评价肝静脉剥夺术(LVD)与门静脉栓塞(PVE)治疗剩余肝体积(FLR)不足的肝脏恶性肿瘤的效果及预后。方法本研究根据PRISMA指南完成,PROSPERO注册号:CRD42024533292。检索PubMed、Embase、Cochrane Library、Web of Science、知网、万方、维普等数据库中关于LVD与PVE效果比较的所有文献。根据制定的纳入和排除文献标准,筛选相关文献,评估文献质量,提取相关LVD与PVE的临床对比资料,整理并分析数据。使用RevMan 5.3软件进行Meta分析。结果共纳入12篇文献(均为队列研究),含644例患者(LVD组245例,PVE组399例)。Meta分析结果显示,在栓塞后FLR增长率(SMD=0.84,95%CI:0.59~1.09)、栓塞后FLR每日增长体积(SMD=1.19,95%CI:0.64~1.73)、栓塞后并发症发病率(RR=1.59,95%CI:1.06~2.38)、栓塞与二期手术间隔时间(SMD=-0.81,95%CI:-1.32~-0.29)和二期手术完成率(RR=1.09,95%CI:1.01~1.18)两组间差异均有统计学意义(P值均<0.05)。结论LVD相较于PVE能够使患者在相对较短的时间内获得达到手术指征的FLR,从而降低疾病进展的发生率以及解决肥大不足的问题,达到更高的二期手术切除率,从而使更多的肝癌患者受益。并且,LVD在二期手术中具有和PVE相似的安全性。
文摘Objective: To differentiate diffuse liver cancer from portal cirrhosis by using ultrasonography. Methods: We analyzed the sonographic images of 15 patients with diffuse liver cancer and 30 patients with portal cirrhosis. Results: The patients with diffuse liver cancer showed enlarged liver and obvious echo of nodules. The rate of portal embolism and swelling of lymph nodes a- round the porta hepatis was high. The patients with portal cirrhosis showed diminished liver and the obvi- ous echo of fiber proliferation. The rates of spleen enlargement and ascites as well as gallbladder edema were high. Conclusions: To identify sonographic characteristics inside and outside of the liver. It is helpful in diffe- rentiating diffuse liver cancer from portal cirrhosis. The sonographic characteristics inside the liver in- clude surface and size, node echo, echo of fibrous tissue hyperplasia. They are difficult to identify when diffuse liver cancer merges with considerable cirrho- sis. The acoustic image characteristics of the two di- seases overlap. Hence attention should be paid to the size of the liver, proliferation of cells of diffuse liver carcinoma. In sonographic characteristics outside the liver, embolism of the portal vein and swelling of lymph nodes in the porta hepatis are particularly use- ful to identify diffuse liver cancer or diffuse liver cancer combined with liver cirrhosis in particular.
