肝硬化门静脉高压症分流术和断流术疗效比较的Meta分析  

Portasystemic shunt vs gastroesophageal devascularization for treatment of portal hypertension:one Meta-analysis

作　　者：蒋安[1] 李宗芳[1] 王志东[1] 周蕊[1] 黎一鸣[1] 杨正安[1] 普彦淞[1] 郭彦锋[1] 

机构地区：[1]西安交通大学医学院第二附属医院外科,710004

出　　处：《中华普通外科学文献（电子版）》2010年第1期61-64,共4页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的通过Meta分析对分流术(PSS)和断流术(GD)治疗门静脉高压症(PH)的疗效进行综合比较。方法通过在Medline、Elsevier、中国期刊全文数据库、万方数据库检索1989至2008年发表的有关PSS和GD治疗门静脉高压症的相关文献,选择RevMan5.0软件用固定效应模型进行Meta分析。结果按照入选标准,有10项临床试验纳入。Meta分析结果显示,分流术的手术死亡率与断流术相似[RR=1.04,95%CI:0.74～1.47,P>0.05],术后再出血率低于断流术[RR=0.48,95%CI:0.39～0.59,P<0.01],术后肝性脑病发生率高于断流术[RR=2.85,95%CI:2.14～3.80,P<0.01],远期死亡率也高于断流术[RR=1.25,95%CI:1.01～1.55,P<0.05]。结论分流术和断流术均是治疗肝硬化门静脉高压症的有效术式,但断流术更适合我国门脉高压症患者。Objective To systematically evaluate the therapeutic effect of portasystemic shunt （PSS） and gastroesophageal devascularization （GD） on portal hypertension （PH） after liver cirrhosis. Methods The litera- tures about the therapeutic effect of PSS and GD on PH after cirrhosis were collected from Medline, Elsevier, China National Knowledge Infrastructure （CNK1） and Wanfang databases from 1989 to 2008. RevMan 5.0 software was used for data analysis. Results According to the included criteria, 10 clinical trials were selected finally. The combined results of Meta-analysis with fixed effect model showed that the Operative Mortality was similar [RR=l.04, 95% CI（0.74-1.47）,, P 〉0.05]; Recurrent variceal bleeding rate of PSS was lower than GD[RR=0.48, 95% CI （0.39-0.59）, P〈0.01]; Encephalopathy rate of PSS was higher than GD[RR=2.85, 95% CI（2.14-3.80）, P〈0.01], while post operative mortality of PSS was higher than GD[RR=l.25, 95% CI（1.01-1.55）, P〈0.05]. Conclusion PSS and GD may be used in the treatment of PH, but in comparing with PSS, GD has a better effect on PH after cirrhosis.

关 键 词：高血压 门静脉 治疗 静脉曲张 肝性脑病 死亡率 META分析 

分 类 号：R657.3[医药卫生—外科学]