摘要：
目的:系统评价胸腔化疗联合热疗治疗肺癌胸水的有效性及安全性.方法:系统检索Cochrane Li-brary、PubMed、EMbase、Web of Science、CBM、CNKI、维普及万方等数据库,配合补充检索手段,收集所有比较胸腔化疗联合热疗与单一疗法的随机对照试验.逐步进行文献筛选和资料提取,评估纳入文献的偏倚风险,应用RevMan 5.3软件进行Meta分析.结果:共纳入23篇随机对照试验(1329例患者).有效性评价:联合组的总有效率、完全缓解率及生活质量改善率均高于单纯胸腔化疗组,且其差异均有统计学意义(P<0.05),其合并效应量分别为[OR=3.95,95%CI=(3.04,5.13)]、[OR=2.80,95%CI=(2.13,3.68)]、[OR=3.11, 95%CI=(2.34,4.14)].安全性评价:联合组的胸痛、白细胞下降、恶心呕吐、肾脏损害及发热的发生率均低于单纯胸腔化疗组,但只有胸痛发生率在两组之间的差异有统计学意义(P<0.05),其合并效应量为[OR=0.57,95%CI=(0.34,0.93)].结论:与单纯胸腔化疗相比,联合疗法可提高近期疗效,显著改善患者生活质量,并且临床安全性较好,但其长期疗效和安全性评价尚需大样本高质量的研究进一步验证.%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.
