Tace Combined With Pse In The Treatment Of Primary Liver Cancer Complicated With Portal Hypertension And Hypersplenism Effect Evaluation: A Meta-Analysis

Objective To evaluate the effective and safety of transcatheter arterial chemoembolization(TACE) combined with partial splenic artery embolization(PSE) versus TACE alone in the treatment of primary hepatocellular carcinoma complicated with portal hypertension and hypersplenism.Method CBM, CNKI, Wanfang, VIP, PubMed, MEDLINE, Springer, EMBASE, Cochrane, Elsevier database and so on were searched, collected all comparison of TACE combined with PSE versus TACE along treatment of primary liver cancer complicated with portal hypertension and hypersplenism clinical randomized controlled trials(RCTs) literatures. Select the documents according to the inclusion criteria, extract the relevant data, conduct Meta-analysis using RevMan5.3.Result A total of 17 articles and 1215 patients were included in the research. The results of meta-analysis showed that white blood cell(WBC) and platelet(PLT) levels of the TACE combined with PSE group(treatment group) 1-3 day, 1 weeks, 2 weeks and 4 weeks posttreatment were significantly higher than those in the TACE group(control group), the difference was statistically significant; Red blood cell(RBC) levels posttreatment of the treatment group were significantly higher than that of the control group, the difference was statistically significant, but the subgroup analysis according to the posttreatment time showed there was no significant difference between the treatment group and the control group; CD4+%, CD4+%/CD8+% of the treatment group was significantly higher than the control group, while the CD8+% level was significantly lower than the control group, the difference was statistically significant; Alanine aminotransferase(ALT) level of the treatment group and the control group without significant difference, total bilirubin(TB) of the treatment group was significantly lower than that of the control group, the difference is statistically significant; Subgroup analysis showed that TB level 1 week posttreatment in the treatment group was significantly lower than that of the control group, the difference is statistically significant, but has no significant difference between the two groups 4 weeks posttreatment; Patients’ degree of esophageal and gastric varices in the treatment group posttreatment were significantly relieved compared with the control group, and the difference is statistically significant; There was no significant difference of Partial remission rate, 6 months and 1 year survival rate between the two gruops; In the treatment group, pain, fever, nausea, vomiting, left pleural effusion, abdominal distension occurred rate was significantly higher than that of the control group, esophageal and gastric varices hemorrhage incidence was significantly lower than that of the control group, the difference were statistically significant; Ascites or ascites increased and intractable hiccup occurred rate posttreatment had no significant difference in two groups.Conclusion Compared with the simple TACE, TACE combined with PSE in treatment of primary hepatocellular carcinoma with portal hypertension and hypersplenism can significantly improve the peripheral blood cell levels, ease of portal hypertension, enhance anti-tumor immune ability and have less effect on the liver function, postoperative complications were mild, safe and reliable.