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Objective:To evaluate the clinical efficacy and safety of ex vivo liver resection and autotransplantation (ELRA) by using a Bayesian single-arm Meta-analysis.Methods:Databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang were searched from January 1, 1990 to December 30, 2021 on ELRA studies. The Bayesian one-arm Meta-analysis was performed by using the statistical software of R (V4.1.2) and the Markov chain-Monte Carlo method was used to simulate the posterior distribution. The mortality rate within 30 days after operation, 1-year survival rate, major postoperative complications, R 0 resection rate and other related indexes were analyzed. Results:A total of 20 studies with 436 patients were included. Bayesian single-arm Meta-analysis showed that the 1-year survival rate after ELRA was 83.24% [95% highest posterior density ( HPD): 72.40%-92.05%]. The 1-year survival rates after surgery were 88.66% (95% HPD: 81.52%-94.50%) for patients with hepatic alveolar echinococcosis and 61.29% (95% HPD: 38.53%-93.68%) for patients with hepatic malignancies, respectively. The mortality rate within 30 d after surgery, the incidence of significant postoperative complications, and the R 0 resection rate were 6.96% (95% HPD: 4.47%-10.15%), 27.91% (95% HPD: 19.00%-38.30%), and 99.84% (95% HPD: 37.61%-100.00%), respectively. Renal failure was the most frequent cause of death after ELRA. Conclusion:ELRA is indicated for hepatic malignancies and hepatic alveolar echinococcosis when intrahepatic resection cannot be accomplished in vivo. The greatest benefit is observed in patients with hepatic alveolar echinococcosis, while only some patients with hepatic malignancies can benefit. The indications for ELRA for hepatic malignancies need to be further studied to define the subgroup of patients who can benefit from this operation.
RESUMEN
Objective To study the clinical efficacy and safety of Silybin-nanosuspension in the treatment of liver cancer.Methods 56 patients with liver tumor were collected from February 2014 to May 2015 in our hospital,and all patients were randomly divided into treatment group(n=24)and control group(n=32).The treatment group was treated with oral Silybin-nanosuspension 360mg(Silybin)and control group was treated with Silybin capsule 360mg(Silybin),once a day.The treatment was over once the following conditions appear,the disease progression,or intolerable toxicity,or the lesion site can be treat with surgery,or patient death.Evaluating the efficacy through comparing the data of objective response rate,disease control rate, progression-free survival and overall survival,and record the adverse reactions through measuring the values of indicators of blood toxicity ( leukocytes, neutrophils,platelets and hemoglobin ) and the liver function parameters ( Valley alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase) .Results The objective response rate, disease control rate, progression-free survival and overall survival of treatment group were significantly better than control group(P<0.05),and the parameters of blood toxicity and liver function were no significant differences.Conclusion The Silybin-nanosuspension is safe and effective for the treatment of liver malignancies.