患者,女,63岁,因“左侧颈部淋巴结肿大3个月,左侧乳房肿块1周”于2018年7月入院.患者于2018年4月无意发现左颈部淋巴结肿大,约鸡蛋大小,活动度欠佳,部分融合,无压痛、发热、头痛、头晕等症状,中药、抗生素治疗后无明显效果.2018年6月患者发现左侧乳房外上肿块,大小约5.0cm×5.0cm×2.0 cm,质硬,无压痛,无橘皮样变和乳房疼痛,乳头无溢液,遂行乳腺超声检查结果示左侧乳腺多发占位性病变?建议手术,取病理组织活检.既往史:子宫内膜息肉、胆囊炎伴结石手术史,2型糖尿病5年余,血糖控制可,空腹血糖约7 mmol/L.

目的 系统评价贝伐珠单抗联合化疗腹腔注射治疗卵巢癌腹腔积液的疗效和安全性.方法 计算机全面检索中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普(VIP)和万方(Wanfang)、The Cochrane Library、PubMed、EMbase等数据库,同时结合其他检索,收集贝伐珠单抗联合化疗腹腔注射治疗卵巢癌腹腔积液的随机对照试验(randomized controlled trials,RCTs).依据Cochrane系统评价手册采用RevMan5.3软件进行统计分析.结果 共纳入6篇RCTs,共416例患者.Meta分析结果 发现,贝伐珠单抗联合化疗腹腔注射组(试验组)的完全缓解率、总有效率、疾病控制率、生活质量改善率、生活质量总稳定率均优于单纯腹腔化疗组(对照组),差异有统计学意义(P<0.05);白细胞计数减少、消化道反应、发热、血小板计数减少、血红蛋白减少、肝脏、肾功能异常、疼痛、疲乏两组发生率比较,差异无统计学意义(P>0.05).结论 与单纯腹腔化疗比较,贝伐珠单抗联合化疗腹腔注射治疗卵巢癌腹腔积液方法 更优,且安全性良好,但本研究仍有不足之处,尚需开展大样本、高质量的RCT进一步验证.

目的:系统评价针灸联合疗法治疗慢性疲劳综合征(CFS)的临床有效性及安全性.方法:电子检索国内外数据库,外文数据库包括Web of Science、PubMed、The Cochrane Library及Embase,中文数据库包括中国知网(CNKI)、万方数据(WANFANG DATA)、中国生物医学文献数据库(CBM)和维普中文科技期刊数据库(VIP),文献语种不限,最终检索时间为2018年11月1日.收集所有针灸联合疗法治疗CFS的随机对照试验(RCT),应用RevMan 5.3版软件进行Meta分析.结果:共纳入18篇RCT(1329例患者).1)对比单纯针刺的定量分析结果显示,针灸联合疗法能显著提高治愈率[OR =2.08,95％CI=(1.37,3.14),P＜0.05]及总有效率[OR=3.43,95％ CI=(2.39,4.93),P＜0.05],并显著改善CFS患者的疲劳症状评分[MD =3.86,95％ CI=(2.94,4.78),P＜0.05].2)定性综合分析表明针灸联合疗法的临床效果优于口服中药或西医治疗.结论:针灸联合疗法治疗CFS的临床效果良好.

目的:系统评价灸法治疗癌因性疲乏(Cancer-Related Fatigue,CRF)的有效性及安全性.方法:电子检索PubMed、CNKI等国内外共8个数据库,收集所有灸法治疗CRF的随机对照试验(Ran-domized Controlled Trial,RCT),以定量或定性的方法进行分析.结果:共纳入28篇RCT论文(2249例患者),其中灸法联合组患者1125例,对照组患者1124例.Meta分析显示,相比于常规基础疗法,灸法联合治疗能显著提高CRF治疗的总有效率[OR=5.21,95％CI=(2.66,10.19)],显著降低中重度CRF患者的数量[OR=0.30,95％CI=(0.22,0.41)],显著改善患者的CRF评分[MD=1.91,95％CI=(1.29,2.52)],且组间差异均有统计学意义(P<0.05).定性分析结果显示,相比于常规基础疗法,灸法联合治疗能提高患者的生活质量、抗癌有效性和安全性,并有效改善患者的抗癌免疫机能.结论:中医灸法治疗CRF安全有效,应在临床中大力推广.

目的 系统评价子午流注针法治疗失眠症的有效性及安全性.方法 电子检索PubMed、中国知网等国内外共8个数据库,收集所有子午流注针法对比常规针刺治疗失眠症的随机对照试验(RCT),应用RevMan 5.3版软件进行Meta分析.结果 共纳入17项RCT(1084例患者).Meta分析结果显示:与常规针刺相比,子午流注针法能显著提高失眠症治疗的痊愈率、显效率、总有效率、睡眠率改善度及睡眠质量评分改善度,组间差异均存在统计学意义(P<0.05).结论 与常规针刺相比,子午流注针法治疗失眠症效果更佳,有助于患者睡眠质量的进一步提高.

目的 系统评价五音疗法治疗失眠症的临床有效性及安全性.方法 2018年电子检索PubMed、CNKI等国内外共8个数据库,收集所有五音疗法治疗失眠症的随机对照试验(randomized controlled trial,RCT),应用RevMan 5.3版软件进行Meta分析.结果 共纳入24篇RCT(2 361例患者),(1)定性综合分析表明五音疗法治疗失眠症安全有效.(2)定量分析结果显示五音疗法能提高患者痊愈率(OR =2.52,95％CI:1.90～3.33,P＜0.05)及总有效率(OR=2.68,95％CI:1.94～3.69,P＜0.05),并改善失眠症患者的匹兹堡睡眠质量指数量表(pittsburgh sleep quality index,PSQI)评分(MD=2.08,95％CI:1.42～2.73,P＜0.05).结论 五音疗法治疗失眠症安全性良好且临床效果明显.

目的:评价腹腔热灌注化疗(intraperitoneal hyperthermic perfusion chemotherapy,IHPC)治疗进展期胃肠癌的疗效与安全性.方法:检索Cochrane Library、PubMed、中国知网、中国生物医学文献数据库、中国科技期刊数据库和万方数据库等,辅以其他检索,收集单一IHPC或IHPC联合全身静脉化疗(intravenous chemotherapy,IC)对比IC治疗进展期胃肠癌的随机对照试验(randomized controlled trials,RCTs).本文采用Cochrane系统评价手册推荐的标准和RevMan5.3软件对纳入文献进行质量评价和数据分析.结果:纳入29篇RCTs,共2 685例患者.Meta分析结果:IHPC组的有效缓解率、完全缓解率、1生存率、3生存率和5年生存率高于IC组,OR和95％CI分别为(2.88,2.25 ～3.69)、(2.16,1.57 ～2.98)、(2.10,1.54 ～2.88)、(2.80,2.19～3.58)和(2.71,1.81 ～4.05),其差异均有统计学意义(P ＜0.000 01).同时,IHPC组复发率、远处转移率及肝转移率低于IC组,其差异均有统计学意义(P＜0.05).就安全性而言,两组胃肠道反应、腹痛、腹泻、肝脏损害、肠梗阻、神经毒性发生率的差异均无统计学意义(P＞0.05);但白细胞减少、腹胀及肾脏损害的发生率差异均有统计学意义(P＜0.05).结论:与IC相比,IHPC或IHPC+ IC治疗胃肠癌的疗效较好,安全性可接受,但仍需要更大的多中心RCT研究来证实,以利于今后IHPC疗法在临床中更好的应用.

目的:初步探讨癌因性疲乏(CRF)与神经内分泌的相关性,为CRF生物学机制的迸一步研究提供参考依据.方法:纳入59例康复期肺癌患者,按照患者的CRF分为疲乏组(39例)和非疲乏组(20例).评估患者的CRF状况并测定患者血清激素水平.结果:疲乏组的血清皮质醇激素及血清甲状腺激素(T3,T4,FT3,FT4)浓度均低于非疲乏组,但血清ACTH浓度高于非疲乏组,且组间差异均具有统计学意义(P<0.05),血清TSH浓度在两组间的差异无统计学意义(P>0.05).疲乏组患者的MFSI-SF评分与血清皮质醇及甲状腺激素浓度均呈负相关(r=-0.820,-0.893,-0.797,-0.717,-0.855;P<0.05);FSI评分与血清中皮质醇激素浓度及甲状腺激素浓度均呈负相关(r=-0.778,-0.772,-0.659,-0.661,-0.653;P<0.05);MFSI-SF评分、FSI评分与血清ACTH浓度均呈正相关(r=0.813,0.629;P<0.05).结论:康复期肺癌患者的CRF与肾上腺轴及甲状腺轴的神经内分泌相关.疲乏患者的皮质醇及甲状腺激素的水平显著低于非疲乏患者,且其在血清中的浓度会影响患者CRF的程度.

目的 化疗与热疗有协同抗癌作用,为确定热疗在胃癌综合治疗中的临床价值,本研究系统评价了化疗联合热疗治疗中晚期胃癌的有效性及安全性.方法 计算机检索Cochrane Library、PubMed、EMBase和Web of Science等外文数据库,以及中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普中文科技期刊数据库(VIP)和万方数据知识服务平台(WanFang)等中文数据库,配合补充检索手段,收集所有比较联合疗法与单独化疗的随机对照试验(randomized controlled trial,RCT).提取纳入文献资料,包括第一作者、发表时间、样本量、卡氏评分及结局指标等,并进行方法学质量评价.结果 共纳入34篇RCT,合计3018例患者.有效性评价:1(RR=1.13,95％CI为1.07～1.20)、2(RR=1.34,95％CI为1.20～1.50)、3(RR=1.32,95％CI为1.15～1.51)和5年(RR=1.63,95％CI为1.15～2.31)生存率以及完全缓解率(RR=1.90,95％CI为1.50～2.41)、总有效率(RR=1.53,95％CI为1.40～1.67)、生活质量改善率(RR=1.51,95％CI为1.32～1.74)及复发率(RR=0.68,95％CI为0.58～0.80)在联合组和单独化疗组间差异有统计学意义,均P<0.05;联合组的1、2、3和5年生存率以及完全缓解率、总有效率、生活质量改善率均高于单独化疗组,复发率低于单独化疗组.安全性评价:白细胞下降(RR=0.85,95％CI为0.78～0.92)、恶心呕吐(RR=0.80,95％CI为0.73～0.87)、腹痛(RR=0.56,95％CI为0.47～0.67)和腹泻(RR=0.70,95％CI为0.60～0.81)4个指标的发生率在2组间差异均有统计学意义,均P<0.05;联合组中的发生率均低于单独化疗组;手足综合征、脱发、周围神经毒性和肝肾功能损伤等指标发生率在2组间的差异均无统计学意义,均P>0.05.结论 与单独化疗方案治疗中晚期胃癌相比,化疗与热疗的联合方案可提高长期生存率、改善近期疗效、降低患者的复发率,并且有利于降低化疗引起的毒副作用,但该结论尚需高质量的临床研究进一步证实.

Objective To systematically review the efficacy and safety of hyperthermic intraperitoneal perfusion chemotherapy (HIPC) in treatment of advanced colorectal cancer,and to provide the reference for clinical practice and research. Methods Foreign databases as Cochrane Library,PubMed,EMBASE,Web of Science and Chinese ones as CBM,CNKI,VIP and WanFang were searched by computer, and other sources were retrieved as supplying. All rele-vant randomized controlled trials (RCTs) were collected to compare the efficacy and safety of surgery combined with HIPC and surgery without HIPC. After literature screening, data extraction and quality evaluation were independently conducted by two authors according to the protocal,Meta-analysis was performed by the RevMan 5.3 software. Results Twenty-two RCTs involving 2 837 patients were included. Meta-analysis showed: (1) the 1, 2, 3, 5-year survival rates,total effective rate and improving rate of life quality of HIPC group were superior to those of surgery alone group, the recurrence rate and distant metastasis rate of HIPC group were lower than those of surgery alone group, there were significant differences (P<0.05);(2) there were no significant differences in the incidence of leukocytopenia,nausea and vomiting,hepatic lesion,renal lesion,ileus,intestinal fistula,infection of incisional wound,bleeding and pulmo-nary infection between two groups (P >0.05). Conclusion Compared with surgery alone, surgery combined with IHIC for advanced colorectal cancer can improve long-term survival rate and short-term curative effect, reduce recur-rence and distant metastasis rate;additionally,it is safe and feasible. However,safety outcomes should be further eval-uated by larger samples and high quality studies.

Objective:To systematically review the efficacy and safety of intrathoracic chemotherapy combined with thermotherapy(ITCT)for malignant pleural effusion(MPE)of lung cancer.Methods:We searched foreign databas-es as Cochrane Library,PubMed,EMbase,Web of Science and Chinese ones as CBM,CNKI,VIP and WanFang with computer,and also retrieved other sources as supplying.All relevant randomized controlled trials(RCTs)were col-lected to compare ITCT and monotherapy of intrathoracic chemotherapy(ITC)or thermotherapy. After literature screening,data extraction and quality evaluation according to the protocal,Meta-analyses were performed using the RevMan 5.3 software.Results:23 RCTs involving 1 329 patients were included.For efficacy assessment,total effec-tive rate,complete remission rate and improving rate of life quality of ITCT group were superior to ITC group,and there were all significant differences(P<0.05).The combined effects were[OR=3.95,95%CI=(3.04,5.13)], [OR=2.80,95%CI=(2.13,3.68)],and[OR=3.11,95%CI=(2.34,4.14)],respectively.For safety assess-ment,the incidence of stethalgia,leukocytopenia,nausea and vomiting,kidney lesion and fever in ITCT group were lower than ITC group.However,only the incidence of stethalgia had significant difference(P<0.05),and the com-bined effect was[OR=0.57,95%CI=(0.34,0.93)].Conclusion:Compared with ITC,ITCT can significantly im-prove short-term curative effect and life quality of patients with MPE of lung cancer.Additionally,it is safe and feasi-ble.But its long-term survival rate and security still need to be further verified by more large sample and high quality studies.

Objective To systematically review the efficacy and safety of intrathoracic chemotherapy combined with thermotherapy (ITCT) for malignant pleural effusion (MPE).Methods From August 2015 to January 2016,a computerbased retrieval was performed in foreign databases such as Cochrane Library,PubMed,EMBase,Web of Science and Chinese ones such as CBM,CNKI,VIP and Wanfang,and supplementary retrieval was also performed with other sources.All relevant randomized controlled trials (RCTs) were collected to compare ITCT (ITCT group) and monotherapy of intrathoracic chemotherapy (ITC group).We extracted the relevant information from the literatures,including the first author,published time,sample size,age,Karnofsky performance status,chemotherapy regimens and outcome indicators.Then we assessed the methodologic quality of included studies.Results A total of 23 literatures were included,comprising 1 647 patients,including 819 in the ITCT group and 828 in the ITC group.Five studies reported random methods,yet none of the included studies mentioned the concealment of allocation and blinding.The baseline comparability of the two groups had fine balance.One study had loss of follow-up.There was no selective outcome reporting in any of the included studies.Total effective rate [OR =3.72,95％ CI (2.92,4.74)],complete remission rate [OR =2.24,95％ CI (1.81,2.78)] and improving rate of life quality [OR =3.66,95％ CI (2.64,5.07)] of ITCT group were superior to those of ITC group and there were all significant difference (P ＜ 0.05).There were no significant difference between the two groups on the incidence of nausea and vomiting [OR =0.80,95％CI (0.60,1.06)],leukocytopenia [OR=0.81,95％CI (0.60,1.10)],fever [OR =0.98,95％CI (0.69,1.40)],hepatic lesion [OR =0.45,95％ CI (0.11,1.81)],pneumothorax [OR =0.41,95％ CI (0.06,2.91)] and skin scald [OR =5.33,95％ CI (0.91,31.14)].The incidence of stethalgia in ITCT group was lower than ITC group [OR =0.34,95％CI (0.16,0.74)],the incidence of subcutaneous fat scleroma in ITCT group was higher than ITC group [OR =6.27,95％CI (1.08,36.27)],and there were all significant difference (P＜0.05).Conclusion Compared with ITC,ITCT can significant improve short-term curative effect and life quality of patients with MPE;additionally,it is safe and feasible.But its long-term survival rate and security still needs to be further verified by more large sample and high quality studies.

目的:初步探讨癌因性疲乏(CRF)与神经内分泌的相关性,并应用激素干预疗法进行治疗及相关性验证.方法:选取康复期肺癌患者进行研究.按照纳入及排除标准,最终纳入59例康复期肺癌患者,按照患者的CRF情况分为疲乏组(39例)和非疲乏组(20例)两组.利用多维疲乏症状量表-简化版(MFSI-SF)和疲劳症状量表(FSI)对所有患者进行调查,评估患者的CRF状况.采集所有纳入患者的清晨8:00静脉血,以电化学发光法检测患者血清皮质醇激素、血清甲状腺激素(T3,T4,FT3,FT4)及促甲状腺激素(TSH)的浓度;以酶联免疫吸附法检测血清中促肾上腺皮质激素(ACTH)的浓度.结果:疲乏组的血清皮质醇激素及血清甲状腺激素(T3,T4,FT3,FT4)浓度均低于非疲乏组,疲乏组的血清ACTH浓度高于非疲乏组,且组间差异均具有统计学意义(P<0.05),血清TSH浓度在两组间的差异无统计学意义(P>0.05).对19例CRF患者激素补充治疗前后的相关指标进行对比.结果显示,激素补充干预后的血清皮质醇及甲状腺激素(T3,T4,FT3,FT4)浓度均高于干预前的水平,激素补充干预后的MFSI-SF评分及FSI评分明显低于干预前的评分,且自身前后对照的差异均有统计学意义(P<0.05).结论:康复期肺癌患者的CRF与肾上腺轴及甲状腺轴的神经内分泌相关,疲乏患者的皮质醇及甲状腺激素的水平显著低于非疲乏患者.激素补充疗法能有效改善康复期肺癌患者的癌因性疲乏,但尚需大样本高质量的研究进一步验证.

Objective To investigate the efficacy and safety of radio - frequency ablation( RFA)combined with percutaneous ethanol injection(PEI)in the treatment of liver cancer and to provide references for clinical practice and research. Methods A computer - based retrieval was made in eight major databases which were Cochrane Library,PubMed,EMBase, Web of Science,CBM,CNKI,VIP and Wanfang and other auxiliary retrieval was also made to collect all relevant controlled clinical trials(CCT). After two researchers made literature screening,extracted data and evaluated the quality of literature included according to research plan,meta - analysis was undertaken using RevMan 5. 3 software. Results A total of 15 CCT with 1 374 patients were included. The results of Meta - analyses showed:RFA + PEI group was higher in 1 - year,2 - year and 3 - year survival rates and complete necrotic rate and was lower in locoregional recurrence rate than RFA group(P < 0. 05);apart from fever,RFA + PEI group did not increase the incidence rates of other complications and adverse reactions. RFA + PEI group was higher in 1 - year survival rate and complete necrotic rate and was lower in locoregional recurrence rate than PEI group (P < 0. 05). Conclusion Compared with pure RFA or pure PEI treatment,RFA combined with PEI can improve the survival rate and complete necrotic rate and lower locoregional recurrence rate with better clinical safety,while its long - term efficacy and safety need further verification by more high - quality clinical researches with lager samples.

目的 评价唑来膦酸联合化疗治疗多发性骨髓瘤(MM)的有效性及安全性,为临床实践与研究提供参考.方法 计算机检索Cochrane Library、PubMed、EMBASE、Web of Science、中国生物医学文献数据库、中国期刊全文数据库、万方数字化期刊全文数据库和维普中文科技期刊数据库,同时辅以其他检索,收集所有唑来膦酸联合化疗治疗MM的随机对照试验(RCT).评价员按照研究计划书进行文献筛选和资料提取,对纳入文献进行质量评价后,使用RevMan 5.3软件进行Meta分析.结果 共纳入13篇RCT (565例患者).Meta分析结果显示:联合组的骨痛缓解显效率及总有效率均高于单独化疗组,差异均有统计学意义(P＜ 0.05),合并结果为显效率[OR=3.56,95％CI=(2.27,5.60)],总有效率[OR=4.42,95％CI=(2.77,7.07)];联合组的骨病变和病理性骨折发生率均低于单独化疗组,但只有骨病变发生率的差异有统计学意义(P＜0.05),合并结果为骨病变[OR=0.34,95％CI=(0.18,0.64)];联合组的发热、疲劳、恶心、便秘及肾功能损伤的发生率均高于单独化疗组,但只有发热和便秘发生率的差异有统计学意义(P＜0.05),合并结果为发热[OR=5.15,95％CI=(2.00,13.26)]、便秘[OR=9.69,95％CI=(1.15,81.81)].结论 相较于单独化疗,唑来膦酸联合化疗治疗MM能显著提高患者骨痛缓解率,降低患者骨病变的发生率,但同时也增加了发热和便秘的风险.

Objective To systematically review the efficacy and safety of chemo-radiotherapy combined with hyperthermia (HCRT) for rectal cancer,and to provide evidence for clinical practice.Methods We searched the Cochrane Library (Issue 6,2014),PubMed,EMbase,Web of Science,CBM,CNKI,VIP and WanFang Data databases from inception to July 2014.All relevant randomized controlled trials (RCTs) of HCRT for rectal cancer were collected.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies.Then meta-analysis was performed using RevMan 5.3 software.Results A total of 9 RCTs involving 663 patients were included.The results of meta-analysis showed that:Compared with the chemo-radiotherapy (CRT) group,the HCRT group were significant superior in complete response (OR=3.74,95％CI 2.14 to 6.53),total effective rate (OR=4.23,95％CI 2.69 to 6.66),3-year survival rate (OR=4.48,95％CI 1.81 to 11.06) and recurrence rate (OR=0.19,95％CI 0.09 to 0.42).Compared with the radiotherapy (RT) group,the HCRT group was associated with significant improvement in complete response rate (OR=3.01,95％CI 1.24 to 7.29).Conclusion Current evidence shows,HCRT is superior to CRT or RT in the treatment of rectal cancer.However,due to the limited quantity and quality of the included studies,more high quality studies are needed to verify the above conclusion.

Objective:To evaluate efficacy and safety of radiofrequency ablation(RFA)treatment on advanced non-small cell lung cancer(NSCLC).Methods:Relevant randomized controlled trials(RCTs)and controlled trials (CTs)were obtained from the Cochrane Library,PubMed,EMbase,CBM,CNKI,VIP and WanFang databases.RCTs and CTs of RFA combined with either CTY or RCTY on advanced NSCLC were also included before Nov,2014.Two researchers evaluated the quality of the items included.The data included in the study were evalusted and analyzed u-sing the Cochrane Collaboration's RevMan 5.2 software.Results:A total number of 16 studies involving 980 patients were included.The results of Meta -analysis showed that compared to CTY group,RFA plus CTY group can improve advanced NSCLC patients'6 months,1 ,2 and 3 -year survival rate (OR =5 .5 7 ,95 % CI :2 .90 ~1 0 .70 ), (OR =2.01,95%CI:1.41 ~2.86),(OR =2.48,95%CI:1.51 ~4.07),(OR =2.29,95%CI:1.24 ~4.22),were higher obviously(P <0.05),and no additions on complications and adverse reactions(P >0.05).In addition,com-pared to RCTY treatment,the RFA plus RCTY could improve overall rate survival rate of advanced NSCLC patients in a 1 -year period (OR =2.09,95%CI:1.11 ~3.94).Similarly,the RFA plus RCTY could improve the KPS(OR=3.25,95%CI:1.60 ~6.61 ),were higher obviously and had the statistical significant(P <0.05).Conclusion:Compared to CTY alone,the RFA plus CTY solution has significant advantages on the survival rate of advanced NSCLC patients had no increase on complications and adverse reactions.Compared to RCTY,RFA plus RCTY can im-prove the survival rate and living quality of the patients.

Objective: To evaluate the efficacy and safety of intraperitoneal hyperthermal perfusion chemotherapy(IHPC) combined with intravenous chemotherapy (IC) for malignant ascites. Methods:We searched international (Cochrane Library, PubMed and EMBASE) and Chinese (CBM, CNKI, VIP and Wangfang) datebases for relevant articles and imported other retrievable sources, such as tracing related references, to obtain certain inaccessible information. All relevant randomized controlled trials (RCTs) were collected to compare IHPC plus IC with IC alone. Two researchers have evaluated the quality of the items included in the research, extracted related data, and performed cross-check. The data included in the study were analyzed and synthesized using the Cochrane Collaboration's RevMan 5.2 software. Results: A total Number of 8 studies involving 522 patients were included. The results of Meta-analysis showed that the IHPC group had higher rates of improvement in total effective rate (OR=3.17,95%CI:2.02-4.97) and complete remission rate (OR=2.76,95%CI:1.65-4.62), and there were no significant differences between the two groups in adverse reactions. Conclusion:Compared with IC alone, IHPC plus IC has significant advantages on total effective and complete remission rate, and also had no increase on adverse reactions, security was good.

目的 评价经导管动脉化疗栓塞术(TACE)联合微波消融(MWA)治疗原发性肝癌的有效性及安全性,为临床实践与研究提供参考.方法 计算机检索Cochrane Library、PubMed、EMbase、Web of Science、CBM、CNKI、WanFang及VIP 8个数据库,同时辅以其他检索,收集所有TACE联合MWA治疗原发性肝癌的随机对照试验(RCT).评价员按照研究计划书进行文献筛选和资料提取,并对纳入文献进行质量评价后,使用RevMan 5.3软件进行Meta分析.结果 共纳入19篇RCT(1 356例患者).Meta分析结果显示:①联合组0.5年、1年、1.5年、2年和3年的总生存率均明显好于TACE组,且其差异均有统计学意义(P＜0.05);合并结果分别为0.5年[RR=1.24,95％CI=(1.12,1.37)],1年[RR=1.50,95％CI=(1.38,1.62)],1.5年[RR =2.05,95％CI=(1.38,3.06)],2年[RR=1.97,95％CI=(1.65,2.36)],3年[RR =3.39,95％CI=(2.32,4.96)].②联合组的完全缓解率、总有效率、完全坏死率和甲胎蛋白(AFP)的转阴率均高于单独TACE组,联合组的复发率低于单独TACE组,且其差异均有统计学意义(P＜0.05);合并结果分别为完全缓解率[RR=2.53,95％CI=(1.45,4.41)],总有效率[RR=1.69,95％CI=(1.43,1.99)],完全坏死率[RR=2.51,95％CI=(1.87,3.36)],AFP转阴率[RR=1.49, 95％CI=(1.28,1.73)],复发率[RR=0.28,95％CI=(0.15,0.52)].结论 相比较单用TACE治疗,TACE联合MWA治疗原发性肝癌能提高患者近期疗效和远期生存率,降低复发率,且安全性仍较好.

目的:系统评价放疗联合热疗治疗直肠癌的有效性及安全性,为临床实践与研究提供参考.方法:计算机检索Cochrane Library、PubMed、EMBASE、Web of Science和中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普中文科技期刊数据库(VIP)、万方数字化期刊数据库(WanFang),同时辅以其他检索.收集有关热放联合疗法治疗直肠癌的随机对照试验(randomized controlled trials,RCTs).评价员按照研究计划书进行文献筛选和资料提取,并对纳入文献进行质量评价后,使用RevMan 5.3软件进行Meta分析.结果:共纳入8篇RCT(573例患者).Meta分析结果显示:联合组的2、3、4年生存率、完全缓解率、总有效率及症状缓解率均明显好于单独放疗组,2组差异均有统计学意义(P＜0.05),其RR值和95％CI分别为(RR=1.50,95％CI=1.10～2.06)、(RR=1.77,95％CI=1.06～2.98)、(RR=1.82,95％CI=1.04～3.17)、(RR=2.55,95％CI=1.55～4.19)、(RR=1.62,95％CI=1.34～1.96)、(RR=1.18,95％CI=1.03～1.34);热放联合组急性毒性反应的发生率低于单放组,但其差异无统计学意义(P=0.05),其RR值与95％CI为(RR=0.72,95％CI=0.51～1.00).结论:相较于单独放疗,放疗联合热疗治疗直肠癌能提高患者远期生存率和近期疗效,而且并不增加毒副反应的发生率.但受纳入研究数量和质量的限制,上述结论仍有待更多大样本高质量的研究予以验证.