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经颈静脉肝内门体分流术与内镜下组织胶注射术治疗胃静脉曲张出血效果的Meta分析
Efficacy of transjugular intrahepatic portosystemic shunt versus endoscopic cyanoacrylate injection in treatment of gastric variceal bleeding: A meta-analysis
文章发布日期:2019年01月07日  来源:  作者:李晶,江泳,张旭  点击次数:731次  下载次数:104次

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【摘要】:目的 通过Meta分析来评估和比较经颈静脉肝内门体分流术(TIPS)与内镜下组织胶注射术治疗胃静脉曲张出血的临床疗效。方法 在PubMed、Embase、Cochrane Library、ScienceDirect、中国知网、万方数据库检索关于TIPS和内镜下组织胶注射治疗胃静脉曲张疗效比较的随机对照试验,检索日期截止到2018年6月30日。对纳入的文献进行评价和提取数据,采用RevMan 5.3软件对数据进行统计分析。结果 本研究共纳入6个随机对照试验,其中TIPS组366例,组织胶组255 例。Meta分析显示:TIPS术后和组织胶术后患者早期再出血率比较差异无统计学意义[比值比(OR)=1.05,95%可信区间(95%CI):0.53~2.06, P=0.89];但晚期再出血率TIPS组低于组织胶组,差异有统计学意义(OR=0.33,95%CI:0.19~0.57,P<0.000 1)。2组患者病死率比较差异无统计学意义(OR=1,95%CI:0.65~1.55, P>0.05)。TIPS术后肝性脑病发生率高于组织胶组,差异有统计学意义(OR=4.09,95%CI:1.59~10.58,P=0.004)。结论 从长远看,TIPS术后胃静脉曲张再出血率明显低于组织胶注射术,是有效的治疗胃静脉曲张的方法。
【Abstract】:Objective To evaluate the clinical efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic cyanoacrylate injection in the treatment of gastric variceal bleeding through a meta-analysis. Methods PubMed, Embase, the Cochrane Library, ScienceDirect, CNKI, and Wanfang Data were searched for the randomized controlled trials (RCTs) of the efficacy of TIPS versus endoscopic cyanoacrylate injection in the treatment of gastric variceal bleeding published up to June 30, 2018. We assessed study quality and extracted data from the included studies. RevMan 5.3 software was used to statistically analyze the data. Results Six RCTs were included, involving 366 cases in the TIPS group and 255 cases in the cyanoacrylate group. The meta-analysis showed no significant difference in the early rebleeding rate between the TIPS group and the cyanoacrylate group (odds ratio [OR]=1.05, 95% confidence interval [CI]: 0.53-2.06, P=0.89), but the postoperative late rebleeding rate of the TIPS group was significantly lower than that of the cyanoacrylate group (OR=033, 95%CI: 0.19-0.57, P<0.000 1). There was no significant difference in the mortality between the TIPS group and the cyanoacrylate group (OR=1, 95%CI: 0.65-1.55, P>0.05). The TIPS group had a significantly increased incidence of postoperative hepatic encephalopathy compared with the cyanoacrylate group (OR=4.09, 95%CI: 1.59-10.58, P=0.004). Conclusions In the long term, the rebleeding rate of gastric variceal bleeding is significantly lower in patients treated with TIPS than in those treated with endoscopic cyanoacrylate injection, so TIPS is an effective method to treat gastric variceal bleeding.
【关键字】:门体分流术, 经颈静脉肝内; 栓塞, 治疗性; 食管和胃静脉曲张; 治疗结果; Meta分析
【Key words】:portasystemic shunt, transjugular intrahepatic; embolization, therapeutic; esophageal and gastric varices; treatment outcome; Meta-analysis
【引证本文】:LI J, JIANG Y, ZHANG X. Efficacy of transjugular intrahepatic portosystemic shunt versus endoscopic cyanoacrylate injection in treatment of gastric variceal bleeding: A meta-analysis[J]. J Clin Hepatol, 2019, 35(2): 349-353. (in Chinese)
李晶,江泳,张旭. 经颈静脉肝内门体分流术与内镜下组织胶注射术治疗胃静脉曲张出血效果的Meta分析[J]. 临床肝胆病杂志, 2019, 35(2): 349-353.

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