断流术和分流断流联合术治疗肝硬化门静脉高压症疗效Meta分析  

Gastroesophageal devascularization vs portasystemic shunt combined with gastroesophageal devascularization for treatment of portal hypertension:a meta-analysis

作　　者：蒋安[1] 李宗芳[1] 张澍[1] 杨正安[1] 郭彦锋[1] 普彦淞[1] 王波[1] 

机构地区：[1]西安交通大学医学院第二附属医院外科,陕西西安710004

出　　处：《中国实用外科杂志》2010年第7期590-593,共4页Chinese Journal of Practical Surgery

基　　金：陕西省科技计划项目[No.2006k12-G3(6)]

摘　　要：目的比较断流术(GD)和分流、断流联合术(PSS+GD)治疗门静脉高压症疗效的差异。方法通过在Medline、Elsevier、中国期刊全文数据库、万方数据库检索2001-2008年发表的有关断流术和分流断流联合术治疗门静脉高压症的相关文献,采用RevMan5.0进行Meta分析。结果按照入选标准,有7项临床试验纳入。Meta分析结果显示,断流术的手术病死率与联合术相当[RR=1.04,95%C(I0.48～2.26),P>0.05],术后再出血率高于联合术[RR=3.62,95%CI(2.36～5.55),P<0.05],二者术后肝性脑病发生率相当[RR=0.69,95%CI(0.40～1.20),P>0.05],二者术后远期病死率差异也没有统计学意义[RR=1.18,95%C(I0.79～1.75),P>0.05]。结论联合术适合于有高危出血因素的肝硬化门静脉高压症病人,断流术适合于一般的门静脉高压症病人。Objective To systematically evaluate the therapeutic effect of gastroesophageal devascularization （GD） and portasystemic shunt combined with gastroesophageal devascularization （PSS＋GD） of portal hypertension（PHT） after liver cirrhosis. Methods The literature about the therapeutic effect of GD and PSS＋GD on portal hypertension after cirrhosis were collected from Medline, Elsevier, China Biological Medicine Disk and Wanfang data between January, 2002 and November, 2008. RevMan 5.0 software was used for data analysis. Results According to the included criteria, 7 clinical trials were selected finally. The combined results of meta-analysis showed that the operative mortality had not significant diffience between the two operation [RR=1.04,95%CI（0.48,2.26）,P〉0.05]; Recurrent variceal bleeding rates of PSS ＋ GD were lower than GD [ RR=3.62,95% CI（2.36, 5.55）,P〈0.05 ]; Encephalopathy rates were similar [ RR=0.69, 95%CI（0.40, 1.20）,P〉0.05 ], while post operative mortality between GD and PSS＋GD were similar also [ RR=1. 18,95%CI （0.79, 1.75）,P〉0.05 ].Conclusion PSS＋GD have a better effect on PHT with high rebleeding risk, and GD is suit for most patients with PHT.

关 键 词：门静脉高压症 静脉曲张出血 分流术 断流术 

分 类 号：R6[医药卫生—外科学]