经皮热消融与肝切除手术治疗小肝癌效果的系统评价

目的：系统评价经皮热消融和肝切除手术治疗小肝癌的效果。方法：通过检索国内外文献数据库，收集关于经皮热消融和手术切除治疗小肝癌的随机对照临床试验。按Cochrane系统评价的方法评价纳入研究的治疗，用RevMan 5.1.17软件对资料进行统计分析。结果：共纳入4篇随机对照临床研究，共683例患者，其中经皮热消融组340例，手术切除组343例。Meta分析结果表明，两种方法治疗后1，3年总生存率，1年无瘤生存率，1年局部肿瘤复发率无统计学差异（均P>0.05）；手术切除组的3年无瘤生存率和2年局部肿瘤复发率优于经皮热消融患组（均P<0.05）；经皮热消融组主要并发症发生率明显低于手术切除组（P<0.05），且经皮热消融组治疗的住院时间短、费用低、患者全身状况更好。结论：经皮热消融治疗小肝癌的近期疗效与手术切除相似，但手术切除治疗小肝癌的远期疗效优于热消融治疗。

Percutaneous thermal ablation versus liver resection for small hepatocellular carcinoma: a systematic review

Objective: To assess the clinical efficacy of percutaneous thermal ablation and liver resection for small hepatocellular carcinoma by means of systematic review. Methods: The randomized controlled trials concerning percutaneous thermal ablation and hepatectomy for treatment of small liver cancer were collected through literature retrieval from native and foreign databases. The quality of included studies was assessed according to the Cochrane systematic review method and statistical analysis of data was performed using RevMan 5.1.17 software. Results: Four randomized controlled studies finally met the inclusion criteria, with a total of 683 patients, of whom, 340 cases underwent percutaneous thermal ablation and 343 cases underwent hepatectomy. The results of meta-analysis indicated that the 1- and 3-year overall survival rate, 1-year tumor-free survival rate and 1-year local tumor recurrence rate in the patients undergoing either of the two methods had no statistical difference (all P>0.05). The 3-year disease-free survival rate and 2-year local tumor recurrence rate in patients undergoing liver resection were better than those in patients with percutaneous thermal ablation (both P<0.05). The incidence of major complications in patients receiving percutaneous thermal ablation was significantly lower than that in patients undergoing liver resection (P<0.05), and patients after percutaneous thermal ablation showed shorter hospital stay, lower cost and better systemic conditions. Conclusion: For small liver cancer, percutaneous thermal ablation and liver resection present similar short-term efficacy, but liver resection has better long-term results.