卵巢癌术后孤立性脾转移循证治疗一例

目的 借助循证医学的方法为一例临床罕见卵巢癌术后脾转移患者确定治疗目标和方案.方法 充分评估患者情况,提出临床问题,从Cochrane Library、CNKI、万方数据库、PubMed、Embase和ScienceDirect数据库检索相关证据,检索时间截至2009年10月.对所获证据进行评价,并结合医生经验及患者愿望制定治疗方案.结果 共检索出英文文献15篇,中文文献11篇.Cochrane数据库内尚无卵巢癌术后脾转移治疗方面的RCT,PubMed、Embase和ScienceDirect数据库含5篇综述类文章,CNKI和万方数据库含回顾性队列研究1篇,其余均为个例报道.综合分析检索结果,为患者制订相对合理方案,经20个月随访,该方案适合.结论 本例属罕见病例,虽然循证证据强度偏低,不能充分体现循证治疗的价值,但最终治疗结果 满意.本研究可为此类缺乏大型RCT的罕见病例运用循证思维诊治提供参考.

Evidence-Based treatment for rare solitary splenic metastasis of an ovarian carcinoma in a female patient

Objective Evidence-based medicine was used to make an individualized treatment plan for rare solitary splenic metastasis of an ovarian carcinoma in a female patient. Methods After clinical problems were discovered, evidence was collected from the Cochrane Library, PubMed, EMBASE, ScienceDirect, CNKI and Wanfang databases according to our predefined search strategy. The search was done until October, 2009. The validity of the evidence was assessed. The evidence, combined with the doctor experience and the patient value, was applied to the patient. Results A total of 15 English literature and 11 Chinese literature were identified. A rational treatment plan was made upon a critical evaluation of the data. There were 5 review articles in PubMed, EMBASE and ScienceDirect databases and no RCT in the Cochrane Library. And there was one retrospective cohort study inCNKI and Wanfang databases. The others were all case reports. After 20 month follow-up, the treatment protocol was proven correct. Conclusion The patient has rare disease, and the evidence intension for the evidence-based medicine was low. It can not present the efficacy of the evidence-based medicine treatment sufficiently, though it could provide some suggestion for rare disease which was lack of large RCT for evidence-based Methods .