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目的:比较射频消融术(RFA)与外科手术再切除(SRR)治疗符合米兰标准的术后复发性肝癌的有效性与安全性。方法:检索国内外数据库,收集2000年1月—2017年1月间发表的对比RFA和SRR治疗符合米兰标准的术后复发性肝癌的临床对照试验,用RevMan 5.3软件对符合标准的临床试验数据进行分析。结果:纳入11个临床试验共1 079例患者,其中RFA治疗患者560例(RFA组),SRR治疗患者519例(SRR组)。Meta分析结果显示,两组术后1、3、5年生存率差异均无统计学意义(均P>0.05),但RFA组术后并发症发生率明显低于SRR组(OR=0.25,95%CI=0.14~0.44,P<0.00001)、住院时间明显短于SRR组(OR=-6.57,95%CI=-7.74~-4.09,P<0.00001),而SRR组3年无瘤生存率明显优于RFA组(OR=0.60,95%CI=0.42~0.86,P=0.006)。结论:两种方式治疗符合米兰标准的术后复发性肝癌的临床疗效无显著区别,但RFA具有微创、可重复操作、安全性高等优势。
Objective: To compare the effectiveness and safety of radiofrequency ablation (RFA) and surgical resection (SRR) in the treatment of recurrent hepatocellular carcinoma following Milan criteria. Methods: The domestic and international databases were searched to collect the clinical control trials of contrast-enhanced RFA and SRR published from January 2000 to January 2017 in accordance with the Milan criteria for postoperative recurrent hepatocellular carcinoma. RevMan 5.3 software was used to compare the compliance with standard clinical trial data Analyze. Results: A total of 1 079 patients were enrolled in 11 clinical trials, including 560 RFA-treated patients (RFA group) and 519 SRR-treated patients (SRR group). Meta analysis showed that there was no significant difference in the 1, 3, 5 year survival rates between the two groups (all P> 0.05), but the incidence of postoperative complications in RFA group was significantly lower than that in SRR group (OR = 0.25,95 % CI = 0.14-0.44, P <0.00001). The hospitalization time was significantly shorter than that of SRR group (OR = -6.57, 95% CI = -7.74-4.09, P <0.00001) Better than RFA group (OR = 0.60, 95% CI = 0.42-0.86, P = 0.006). Conclusion: There is no significant difference between the two methods in the treatment of postoperative recurrence of liver cancer in line with the Milan standards. However, RFA has the advantages of minimally invasive, repeatable operation and high safety.