采用覆膜支架经颈静脉肝内门体分流对改善术后分流道狭窄及门静脉高压的系统评价  

TIPS with covered stents improved shunt insufficiency and portal hypertension:a systematic review

作　　者：向谦[1] 李肖[1] 张铭光[1] 唐承薇[1] 

机构地区：[1]四川大学华西医院消化内科,成都610041

出　　处：《中国实用内科杂志》2008年第3期190-193,共4页Chinese Journal of Practical Internal Medicine

摘　　要：目的比较采用覆膜支架和裸支架的经颈静脉肝内门体分流术(TIPS)对改善术后分流道狭窄及门静脉高压的临床疗效的影响。方法检索各大数据库分别采用覆膜支架和裸支架行TIPS后关于临床疗效的对照研究,评价文章质量,运用Revman4.2软件对TIPS分流道狭窄率、门静脉高压相关临床症状复发率和病死率进行分析。结果共获得1340例相关病例,随机对照研究(12.8%对43.9%,P=0.004)与多项非随机对照试验研究(11.6%对57.6%,P<0.01)均表明,覆膜支架较裸支架能明显降低TIPS术后1年分流道狭窄率,两类研究报道的覆膜支架组门静脉高压相关症状的复发率也较裸支架组显著降低(7.7%对29.3%,6.4%对14.5%,P<0.05)。结论覆膜支架在降低TIPS术后分流道狭窄、减少门静脉高压相关临床症状复发方面优于裸支架,这对于改善TIPS术后患者生存时间及质量具有重要意义。Objective To evaluate the improved shunt insufficiency and clinical outcome using covered or bare stents for TIPS. Methods We searched all the main data base to identify trails of TIPS with covered or bare stents in improving shunt insufficiency and clinical outcome and evaluated the quality of included studies. Incidence of shunt insufficiency and clinical relapse relating to portol hypertension were analysed with Revman 4.2, Results Totally 1340 patients undergoing TIPS were included. Randomised controlled （ 12, 8% vs 43, 9%, P = 0. 004 ） trial and non-randomised controlled trials （ 11.6% vs 57.6% ,P 〈0. 01 ）both showed that shunt insufficiency at 1 year was significantly reduced in TIPS with covered stent. Both clinical relapse relating to portol hypertension was also lowered in covered stent（7, 7% vs 29. 3% ,6, 4% vs 14. 5% ,P 〈 0. 05 ）. Conclusion Covered stent is superior in prevention of shunt insufficiency and clinical relapse af- ter TIPS than bare stent, This is important in improving survival rates and life quality in patients undergoing TIPS.

关 键 词：门静脉高压 经颈静脉肝内门体分流术 覆膜支架 

分 类 号：R5[医药卫生—内科学]