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经皮经肝胃冠状静脉栓塞术单独或联合部分脾动脉栓塞术治疗肝硬化门静脉高压出血效果比较的Meta分析

朱军源 夏翊夫 杜艳梅 张春清

引用本文:
Citation:

经皮经肝胃冠状静脉栓塞术单独或联合部分脾动脉栓塞术治疗肝硬化门静脉高压出血效果比较的Meta分析

DOI: 10.12449/JCH240116
基金项目: 

国家自然科学基金 (81970533)

国家自然科学基金 (81770606)

利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:朱军源负责查阅国内外文献,筛选文献,数据分析并撰写论文;夏翊夫负责指导论文撰写和审校;杜艳梅负责筛选文献,数据分析;张春清负责指导论文撰写,审校并最后定稿。
详细信息
    通信作者:

    张春清, 13583188661@163. com (ORCID: 0000-0001-8711-1579)

Efficacy of percutaneous transhepatic variceal embolization alone or in combination with partial splenic embolization in treatment of portal hypertensive hemorrhage in liver cirrhosis: A Meta-analysis

Research funding: 

National Natural Science Foundation of China (81970533);

National Natural Science Foundation of China (81770606)

More Information
    Corresponding author: ZHANG Chunqing, 13583188661@163.com (ORCID: 0000-0001-8711-1579)
  • 摘要:   目的  采用Meta分析对比经皮经肝胃冠状静脉栓塞术(PTVE)联合部分脾动脉栓塞术(PSE)与单独PTVE治疗肝硬化门静脉高压出血的疗效。  方法  本研究根据PRISMA指南完成,PROSPERO注册号:CRD42023396690。检索万方医学网、中国知网、中国生物医学文献数据库、维普数据库、PubMed、Embase、Cochrane Library、Web of Science自建库至2022年12月23日有关对比PTVE联合PSE与单独PTVE两种手术方式治疗肝硬化门静脉高压出血的相关文献;依据纳入及排除标准筛选文献,并提取相关数据,采用RevMan 5.4.1统计分析软件进行Meta分析。  结果  最终纳入文献8篇,总样本量为592例,包括PTVE联合PSE组316例,单独PTVE组276例。Meta分析结果显示,PTVE联合PSE组术后门静脉压力(SMD=-1.75,95%CI:-2.33~-1.16,P<0.05)、术后门静脉内径(SMD=-0.87,95%CI:-1.64~-0.10,P<0.05)、术后再出血率(OR=0.17,95%CI:0.11~0.28,P<0.05)、病死率(OR=0.13,95%CI:0.04~0.37,P<0.05)、术后门静脉高压性胃肠病发生率(OR=0.17,95%CI:0.07~0.45,P<0.05)均低于单独PTVE组;术后血小板水平(SMD=0.79,95%CI:0.52~1.06,P<0.05)高于单独PTVE组。  结论  PTVE联合PSE较单独PTVE可有效降低肝硬化门静脉高压再出血率、病死率、门静脉高压性胃肠病发生率、门静脉压力,缩短门静脉内径,提高血小板水平,是治疗肝硬化门静脉高压出血的有效介入手段。

     

  • 图  1  文献筛选流程图

    Figure  1.  Literature screening flowchart

    图  2  2组术后门静脉压力的Meta分析

    Figure  2.  Comparison of postoperative portal vein pressure

    图  3  2组术后门静脉内径的Meta分析

    Figure  3.  Comparison of postoperative diameter of the portal vein

    图  4  2组术后再出血发生率的Meta分析

    Figure  4.  Comparison of postoperative rebleeding rate

    图  5  2组术后病死率的Meta分析

    Figure  5.  Comparison of postoperative mortality rate

    图  6  2组术后腹水发生率的Meta分析

    Figure  6.  Comparison of the incidence of postoperative ascites

    图  7  2组术后门静脉高压胃肠病发生率的Meta分析

    Figure  7.  Comparison of the incidence of postoperative portal gastrointestinal disease

    图  8  2组术后肝性脑病发生率的Meta分析

    Figure  8.  Comparison of the incidence of postoperative hepatic encephalopathy

    图  9  2组术后血小板水平的Meta分析

    Figure  9.  Comparison of postoperative platelet levels

    图  10  2组术后白蛋白水平的Meta分析

    Figure  10.  Comparison of postoperative albumin levels

    图  11  术后再出血率漏斗图

    Figure  11.  Funnel plot of postoperative rebleeding rate

    图  12  术后再出血率Egger’s检测图

    Figure  12.  Egger’s test chart for postoperative rebleeding rate

    表  1  8篇纳入文献的基本特征及质量评价

    Table  1.   Basic characteristics and quality evaluation of 8 included literature

    第一作者 发表 年份 研究类型 组别 样本量(例) 男/女(例) 年龄(岁) 肝功能Child-Pugh分级(A/B/C,例) 随访时间(月) 文献质量
    权华9 2010 随机对照 PTVE+PSE组 PTVE组 37 56 62/31 18~67 47/36/10 48~69 中等
    Duan16 2014 回顾性 PTVE+PSE组 PTVE组 31 34 21/10 23/11 40.1±10.9 39.7±9.9 4/21/6 6/23/5 6~24
    谢正元15 2015 回顾性 PTVE+PSE组 PTVE组 32 12 25/7 10/2 52.1±10.2 50.5±10.0 4/25/3 2/9/1 6 中等
    刘晓亮12 2016 回顾性 PTVE+PSE组 PTVE组 65 59 79/45 41.8±5.7 21/78/25 6~18 中等
    潘峰13 2018 回顾性 PTVE+PSE组 PTVE组 34 22 23/11 14/8 58.0±14.0 51.0±19.0 31/17/8 3~24
    武和平14 2018 回顾性 PTVE+PSE组 PTVE组 36 13 21/15 8/5 52.35±5.24 50.65±5.21 6/25/5 3/10/0 6 中等
    张明礼10 2019 随机对照 PTVE+PSE组 PTVE组 36 36 28/8 27/9 47.75±4.01 47.72±3.93 0/25/11 0/22/14 中等
    孙巧玉11 2019 随机对照 PTVE+PSE组 PTVE组 45 44 29/16 30/14 66.32±10.71 64.25±9.84 12/24/9 12/25/7 3~12 中等
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