覆膜支架与裸支架对经颈静脉肝内门体分流术远期疗效影响的Meta分析

徐璐; 肖雪; 刘景琪; 王晶; 周晶晶; 姜春萌

doi:10.3969/j.issn.1001-5256.2016.10.015

覆膜支架与裸支架对经颈静脉肝内门体分流术远期疗效影响的Meta分析

DOI: 10.3969/j.issn.1001-5256.2016.10.015

大连医科大学附属第二医院消化内科

详细信息

中图分类号: R575.2
计量
- 文章访问数: 2329
- HTML全文浏览量: 12
- PDF下载量: 485
- 被引次数: 0
出版历程
- 出版日期: 2016-10-20

Influence of covered stent versus bare stent on long-term efficacy of transjugular intrahepatic portosystemic shunt: a Meta-analysis

Department of Gastroenterology and Hepatology, The Second Hospital of Dalian Medical University

摘要

摘要:
目的通过比较经颈静脉肝内门体分流术（TIPS）中应用聚四氟乙烯（PTFE）覆膜支架与裸支架的术后远期疗效,为TIPS的支架选择提供循证医学依据。方法检索中国生物医学文献数据库、万方数据库、中国知网、维普数据库、Medline、Pub Med中1989-2015年发表的有关TIPS治疗肝硬化门静脉高压的对照试验,选取符合纳入标准的研究并对文献进行质量评价。采用RevMan5.3软件对TIPS治疗后支架功能障碍发生率、肝性脑病发病率及1年生存率进行分析,发表偏倚采用漏斗图进行评估。结果共纳入11项研究,包括PTFE覆膜支架组698例及裸支架组1283例患者。Meta分析结果显示,PTFE覆膜支架组的支架功能障碍发生率（14.8%）低于裸支架组（47.0%）,差异有统计学意义[比值比（OR）=0.18,95%可信区间（95%CI）:0.130.24,P<0.001];2组肝性脑病发病率差异无统计学意义（23.5%vs 25.7%,OR=0.88,95%CI:0.661.17,P=0.37）;PTFE覆膜支架组患者术后1年生存率（76.9%）高...
- 高血压,门静脉 /
- 门体分流术,经颈静脉肝内 /
- 支架 /
- Meta分析
Abstract:
Objective To investigate the long-term postoperative efficacy of transjugular intrahepatic portosystemic shunt( TIPS) using polytetrafluoroethylene( PTFE)-covered stent or bare stent,and to provide a basis of evidence-based medicine for the selection of stent in TIPS. Methods CBM,Wanfang Data,CNKI,VIP,MEDLINE,and Pub Med were searched for controlled trials on TIPS in the treatment of cirrhotic portal hypertension published form 1989 to 2015; the studies which met the inclusion criteria were selected,and quality assessment was performed for these articles. Rev Man 5. 3 software was used to analyze the incidence rates of stent dysfunction and hepatic encephalopathy and 1-year survival rate after TIPS,and funnel plots were used to analyze publication bias. Results A total of 11 studies were included,consisting of 698 patients in PTFE-covered stent group and 1283 patients in bare stent group. The results of the meta-analysis showed that the PTFE-covered stent group showed a significantly lower incidence rate of stent dysfunction than the bare stent group( 14. 8% vs 47. 0%,OR = 0. 18,95% CI: 0. 13-0. 24,P < 0. 001). There was no significant difference in the incidence rate of hepatic encephalopathy between the two groups( 23. 5% vs 25. 7%,OR = 0. 88,95% CI: 0. 66-1. 17,P = 0. 37). The PTFE-covered stent group had a significantly higher 1-year survival rate than the bare stent group( 76. 9% vs 62. 7%,OR = 2. 10,95% CI: 1. 54-2. 85,P< 0. 001). The funnel plots which were plotted based on the incidence rates of stent dysfunction and hepatic encephalopathy and 1-year survival rate lacked symmetry,which suggested that a certain degree of publication bias might exist. Conclusion Compared with the bare stent,the PTFE-covered stent can improve stent dysfunction and 1-year survival rate after TIPS,while there is no significant change in the incidence rate of hepatic encephalopathy. Therefore,the PTFE-covered stent has certain advantages over the bare stent in TIPS. In future,multicenter prospective randomized controlled clinical trials with a larger sample size are needed to provide a basis of evidence-based medicine for the application of covered stent in TIPS.
- hypertension /
- portal /
- portasystemic shunt /
- transjugular intrahepatic

HTML全文

参考文献(28)

[1]RSCH J,HANAFEE WN,SNOW H.Transjugular portal venography and radiologic portacaval shunt:an experimental study[J].Radiology,1969,92(5):1112-1114.

[2]RICHTER GM,PALMAZ JC,NLDGE G,et al.The transjugular intrahepatic portosystemic stent-shunt.A new nonsurgical percutaneous method[J].Radiologe,1989,29(8):406-411.

[3]GARCA-PAGN JC,BOSCH J,ACP Journal Club.Early use of TIPS in patients with cirrhosis and variceal bleeding[J].Ann Intern Med,2010,153(10):jc5-jc13.

[4]OWEN AR,STANLEY AJ,VIJAYANANTHAN A,et al.The transjugular intrahepatic portosystemic shunt(TIPS)[J].Clin Radiol,2009,64(7):664-674.

[5]STANG A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J].Eur J Epidemiol,2010,25(9):603-605.

[6]ANGELONI S,MERLI M,SALVATORI FM,et al.Polytetrafluoroethylene-covered stent grafts for TIPS procedure:1-year patency and clinical results[J].Am J Gastroenterol,2004,99(2):280-285.

[7]ANGERMAYR B,CEJNA M,KOENIG F,et al.Survival in patients undergoing transjugular intrahepatic portosystemic shunt:e PTFE-covered stentgrafts versus bare stents[J].Hepatology,2003,38(4):1043-1050.

[8]BARRIO J,RIPOLL C,BAARES R,et al.Comparison of transjugular intrahepatic portosystemic shunt dysfunction in PTFE-covered stent-grafts versus bare stents[J].Eur J Radiol,2005,55(1):120-124.

[9]BUREAU C,GARCIA-PAGAN JC,OTAL P,et al.Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS:results of a randomized study[J].Gastroenterology,2004,126(2):469-475.

[10]CLARK W,GOLKAR F,LUBERICE K,et al.Uncovering the truth about covered stents:is there a difference between covered versus uncovered stents with transjugular intrahepatic portosystemic shunts?[J].Am J Surg,2011,202(5):561-564.

[11]OCKENGA J,KROENCKE TJ,SCHUETZ T,et al.Covered transjugular intrahepatic portosystemic stents maintain lower portal pressure and require fewer reinterventions than uncovered stents[J].Scand J Gastroenterol,2004,39(10):994-999.

[12]TRIPATHI D,FERGUSON J,BARKELL H,et al.Improved clinical outcome with transjugular intrahepatic portosystemic stent-shunt utilizing polytetrafluoroethylene-covered stents[J].Eur J Gastroenterol Hepatol,2006,18(3):225-232.

[13]WU XJ,CAO JM,HAN JM,et al.The retrospective study of transjugular intrahepatic portosystemic shunt with covered or uncovered stents in patients with portal hypertension[J].Chin J Surg,2010,48(2):83-87.(in Chinese)吴性江,曹建民,韩建明,等.覆膜支架和裸支架行TIPS治疗门静脉高压症的对比研究[J].中华外科杂志,2010,48(2):83-87.

[14]LI CQ,LI HL,GUO J,et al.Application of simulative Viatorr technique in TIPS with double stents[J/CD].Chin J Liver Dis:Electronic Edition,2014,6(1):50-54.(in Chinese)李常青,李洪璐,郭江,等.双支架技术在TIPS治疗中的临床应用研究[J/CD].中国肝脏病杂志:电子版,2014,6(1):50-54.

[15]CAI W,ZHUGE YZ,ZHANG JW,et al.Safety and clinical efficacy of TIPS with various stents for treatment of cirrhosis with esophageal gastric varices bleeding[J].Chin J Hepatol,2015,23(4):258-264.(in Chinese)蔡炜,诸葛宇征,张建武,等.不同支架经颈静脉肝内门体静脉分流术治疗肝硬化食管胃静脉曲张出血的安全性和疗效研究[J].中华肝脏病杂志,2015,23(4):258-264.

[16]BAO YJ,GU JP,JI WZ,et al.PTFE-covered stent versus bare stent in transjugular intrahepatic portosystemic stent shunt for portal hypertension[J].Chin J Gen Surg,2014,23(1):81-86.(in Chinese)鲍应军,顾俊鹏,纪卫政,等.PTFE覆膜支架与裸支架在TIPSS治疗门静脉高压症中的疗效比较[J].中国普通外科杂志,2014,23(1):81-86.

[17]CORBETT C,MANGAT K,OLLIFF S,et al.The role of Transjugular Intrahepatic Portosystemic Stent-Shunt(TIPSS)in the management of variceal hemorrhage[J].Liver Int,2012,32(10):1493-1504.

[18]RSSLE M,OCHS A,GLBERG V,et al.A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites[J].N Engl J Med,2000,342(23):1701-1707.

[19]van HA TG,HODGE J,FUNAKI B,et al.Transjugular intrahepatic portosystemic shunt placement in patients with cirrhosis and concomitant portal vein thrombosis[J].Cardiovasc Intervent Radiol,2006,29(5):785-790.

[20]TESTINO G,FERRO C,SUMBERAZ A,et al.Type-2 hepatorenal syndrome and refractory ascites:role of transjugular intrahepatic portosystemic stent-shunt in eighteen patients with advanced cirrhosis awaiting orthotopic liver transplantation[J].Hepatogastroenterology,2003,50(54):1753-1755.

[21]SAXON RR,MENDEL-HARTVIG J,CORLESS CL,et al.Bile duct injury as a major cause of stenosis and occlusion in transjugular intrahepatic portosystemic shunts:comparative histopathologic analysis in humans and swine[J].J Vasc Interv Radiol,1996,7(4):487-497.

[22]MASSON S,MARDINI HA,ROSE JD,et al.Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt insertion:a decade of experience[J].QJM,2008,101(6):493-501.

[23]CLARK TW.Management of shunt dysfunction in the era of TIPS endografts[J].Tech Vasc Interv Radiol,2008,11(4):212-216.

[24]NISHIMINE K,SAXON RR,KICHIKAWA K,et al.Improved transjugular intrahepatic portosystemic shunt patency with PTFEcovered stent-grafts:experimental results in swine[J].Radiology,1995,196(2):341-347.

[25]BUREAU C,PAGAN JC,LAYRARGUES GP,et al.Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts:long-term results of a randomized multicentre study[J].Liver Int,2007,27(6):742-747.

[26]BOYER TD,HASKAL ZJ,American Association for the Study of Liver Diseases.The Role of Transjugular Intrahepatic Portosystemic Shunt(TIPS)in the Management of Portal Hypertension:update2009[J].Hepatology,2010,51(1):306.

[27]ZHU QL,YAN D,YUAN SG,et al.The follow-up visit of the stenosis of eighty e-PTFE covered stent after TIPSS[J].Contemp Med,2011,17(5):23-25.(in Chinese)朱清亮,阎东,袁曙光,等.80例e-PTFE覆膜支架在Tipss术后发生狭窄的随访[J].当代医学,2011,17(5):23-25.

[28]LIANG SN,XU K.Clinical study on transjuguiar intrahepatic portosystemic shunt creation with 8 mm diameter covered stent-graft[J].J Intervent Radiol,2008,17(2):98-101.(in Chinese)梁松年,徐克.TIPS中8 mm直径覆膜支架应用的临床研究[J].介入放射学杂志,2008,17(2):98-101.

施引文献

资源附件(0)

访问统计