吴灶璇　　王桂良　　谭松龄　　邱萍　　徐林芳　　龚敏　　李兴　　文剑波

[摘要] 目的 評价125I粒子联合化疗和单独化疗治疗中晚期胰腺癌的有效性和安全性。 方法 检索中国知网、中国生物医学文献数据库（CBM）、万方及维普数据库、PubMed、Embase、Cochrane Library等中外生物医学数据库，收集125I粒子联合化疗和单独化疗治疗中晚期胰腺癌的随机对照试验（RCT），制订文献纳入与排除标准，筛选文献后提取入选文献数据，采用Stata 12.0统计学软件对数据进行分析。 结果 共纳入10篇文献，共582例患者。125I粒子植入+化疗组患者客观有效率、疼痛缓解率、6个月生存率和12个月生存率均显著优于单纯化疗组（P<0.05）;125I粒子植入+化疗组患者的恶心、呕吐等胃肠道不良反应发生率、白细胞及血小板下降等血液系统不良反应发生率、肝功能损害发生率与单纯化疗组比较，差异无统计学意义（P>0.05），但术后胰瘘、胆瘘、腹腔感染、胰腺炎发生率显著高于单纯化疗组（P<0.05）。 结论 125I粒子联合化疗和单独化疗均能有效治疗晚期胰腺癌，联合方案较单独化疗方案疗效增加，且副作用发生率较低。

[关键词] 125I粒子;胰腺癌;有效性;安全性;Meta分析

[中图分类号] R735.9          [文献标识码] A          [文章编号] 1673-9701（2021）09-0034-05

Meta-analysis of the efficacy and safety of 125I particles combining with chemotherapy and chemotherapy alone in the treatment of advanced pancreatic cancer

WU Zaoxuan   WANG Guiliang   TAN Songling   QIU Ping   XU Linfang   GONG Min   LI Xing   WEN Jianbo

Department of Gastroenterology， Pingxiang Hospital Affiliated to Southern Medical University，  Pingxiang   337000， China

[Abstract] Objective To evaluate the effectiveness and safety of 125I particles combining with chemotherapy and chemotherapy alone in the treatment of advanced pancreatic cancer. Methods The Chinese and foreign biomedical databases such as CNKI， China Biomedical Literature Database（CBM）， Wanfang and Weipu Database， PubMed， Embase， Cochrane Library and so on were searched. The randomized controlled trials（RCT） of 125I particles combining with chemotherapy and chemotherapy alone in the treatment of advanced pancreatic cancer were collected. The literature inclusion and exclusion criteria were established. The data from the selected literature were extracted after screening the literature. The data were analyzed using Stata 12.0 statistical software. Results A total of 10 studies were included， with a total of 582 patients. The objective response rate， pain relief rate， 6-month survival rate， and 12-month survival rate of the 125I particles implantation+chemotherapy group were significantly better than those of the chemotherapy alone group（P<0.05）. There were no significant differences in the incidence of intestinal adverse reactions such as nausea and vomiting， the incidence of blood system adverse reactions such as white blood cell and platelet decline， and the incidence of liver function damage between the 125I particles implantation+chemotherapy group and the chemotherapy alone group（P>0.05）. But the incidence of pancreatic fistula， biliary fistula， abdominal infection， pancreatitis of the 125I particles implantation+chemotherapy group was significantly higher than that of the chemotherapy alone group（P<0.05）. Conclusion Both 125I particles combining with chemotherapy and chemotherapy alone can effectively treat advanced pancreatic cancer. The combined regimen is more effective than chemotherapy alone， and has a low incidence of side effects.

[Key words] 125I particles; Pancreatic cancer; Effectiveness; Safety; Meta-analysis

胰腺癌是消化系统恶性程度最高的肿瘤之一，有“癌中之王”之称，预后极差，5年生存率不到6%[1]。对于胰腺癌的治疗，手术治疗仅适用于早期、体积较小的肿瘤，而对于Ⅲ和Ⅳ期的肿瘤，化疗和体外放疗的副作用较大且疗效不佳[2]，将125I粒子种植至胰腺癌组织进行局部放疗能取得较好的疗效，且越来越受到重视[3]。125I粒子具有体积小、能量低的特点，连续低剂量率照射能抑制肿瘤细胞的有丝分裂，使肿瘤组织的再增生明显减少，同时对正常组织无损伤、毒副作用小[4]。目前，已有大量关于125I粒子治疗胰腺癌的临床研究，但其质量参差不齐，本研究收集了有关125I粒子治疗中晚期胰腺癌的随机对照试验（RCT），进一步系统评价125I粒子治疗中晚期胰腺癌的有效性与安全性，以期为临床治疗提供可靠的借鉴。……