摘要
目的:评价腔内放疗与支架置入治疗食管及食管胃结合部癌所致吞咽困难的疗效。方法:通过计算机检索CBMdisc、VIP、CNKI、Cochrane library、PubMed和Embase等数据库和手工检索8种主要中文肿瘤学期刊,收集腔内放疗与支架置入治疗食管及食管胃结合部癌所致吞咽困难的随机对照试验和半随机对照试验。由2名评价员独立提取数据和评价纳入研究方法学质量,采用Rev Man4.2.10进行统计学分析。结果:共纳入4篇英文文献,269例患者,方法学质量评价均为C级,治疗前吞咽困难评分基线可比。治疗后Meta分析结果显示,腔内放疗组与腔内支架置入组相比,并发症发生率(RR=0.50,95%CI0.32,0.79)差异有统计学意义,而吞咽困难复发率(RR=1.03,95%CI0.63,1.67)、30d死亡率(RR=1.09,95%CI0.62,1.93)、3个月死亡率(RR=0.90,95%CI0.64,1.27)及6个月死亡率(RR=1.20,95%CI0.95,1.52)差异无统计学意义。腔内放疗组患者总体生活质量优于腔内支架置入组。结论:在缓解食管及食管胃结合部癌所致的吞咽困难方面,腔内放疗与腔内支架置入具有相同疗效。但腔内放疗并发症发生率低,且患者远期生活质量较好。鉴于本系统评价纳入文献少,所纳文献方法学质量偏低,在解释上述结论时须慎重。尚需进一步开展设计合理、执行严格、大样本、多中心的随机对照试验。
OBJECTIVE： To evaluate the efficacy of brachytherapy compared with stent placement in the treatment of dysphagia from cancer of esophageal and gastro-esophageal junction. METHODS： CBMdisc, VIP, CNKI, Coehrane Library, PubMed, Embeas etc. were searched by a computer and eight major Chinese journals of ontology were searched by manual. The randomized controlled trials compared braehytherapy with stent placement in the treatment of dysphagia from cancer of esophageal and gastro esophageal junetion were included. The trial methodological quality and extracted data were assossed by 2 reviewers independently, and the statistical software, RevMan 4. 2. 10, was used. RESULTS： Four English artiels were included （269 patients）, and the methodological qualities of all the trials were Grade C, and the baselines of dysphagia scores before the treatment were similar. The results of Meta analysis showed that the complications had a statistical defferrence between the brachytherapy group and stent placement group （RR 0.50, 95%CI 0.32, 0. 79） ; while there was no statistical difference at dysphagia recurrent （RR 1.03, 95 % CI 0.63, 1.67）, mortality of short time （one month RR 1.09, 95% CI0.62, 1.93;three months RR 0.90, 95%CI 0.64, 1.27;six months RR 1.20, 95% CI0.95, 1. 52）in the two groups. The patients in the brachytherapy group had overall better quality of life than those in the stent placement group. CONCLUSIONS： Brachy therapy has the same efficacy in relieving dysphagia from cancer of esophageal and gastro-oesophageal junction as the stent placement, and has the low incidence of complications and long-term better quality of life. However, it should be cautious of interpreting this conclusion due to a few trials and the general low methodological quality. So, more rationally designed and strictly executed RCTs with large samples will be necessary.
出处
《中华肿瘤防治杂志》
CAS
2008年第17期1315-1318,共4页
Chinese Journal of Cancer Prevention and Treatment
关键词
食管肿瘤
胃肿瘤
吞咽障碍
支架
近距离放射疗法
计算机系统
Meta分析
esophageal neoplasms
stomach neoplasms
deglutition disorders, stents
brachytherapy
computer systemas
Meta analysis
