比较内镜套扎与硬化剂预防肝硬化食管静脉曲张再出血:Meta分析  

Comparison of endoscopic ligation with sclerotherapy for preventing cirrhosis esophageal varices bleeding: a Meta analysis

作　　者：陈明锴[1] 何千榆[1] 丁百静 刘云燕[1] 

机构地区：[1]武汉大学人民医院消化内科,武汉430060 [2]芜湖市第二人民医院消化内科,安徽芜湖241000

出　　处：《首都医科大学学报》2013年第5期673-678,共6页Journal of Capital Medical University

基　　金：国家自然科学基金资助项目(81170350);湖北省自然科学基金资助项目(2009CDB283)~~

摘　　要：目的 通过分析比较套扎与硬化注射对食管静脉曲张出血患者的疗效,评价两者在二级预防中的价值.方法 检索Springer、Pubmed、Sinomed、CNKI、Cochrane Library,万方等数据库,用Cochrane图书馆的RevMan5.1软件进行Meta分析.结果 共纳入7项随机对照试验,结果显示,套扎治疗后再出血发生率显著低于硬化治疗（OR=0.54,95%CI：0.38～0.76,Z=3.56,P=0.000）;在降低病死率方面两者疗效相似（OR=0.79,95%CI：0.55～1.14,Z=1.27,P=0.21）;套扎组较硬化组能明显减少合并症（OR=0.22,95%CI：0.13～0.38,Z=5.51,P=0.000）;两组在消除静脉曲张方面效果等同（OR=1.46,95%CI：0.98～2.18,Z=1.88,P=0.060）.制作漏斗图分析发表偏倚,图中落点分布比较对称,表明本研究对纳入文献评价的发表偏倚较小.结论 套扎较硬化注射在食管静脉曲张出血二级预防中疗效更佳,套扎治疗在一般情况下更适合食管静脉曲张出血的二级预防.Objective To evaluate the efficacy of endoscopic variceal ligation （EVL） and sclerotherapy （EVS） for obliteration of esophageal varices among patients who survived an episode of first variceal hemorrhage. Methods The related literature was identified from Pubmed, Medline, Embase, CNKI, the library of Cochrane, and Wanfang database. RevMan 5.1 Software provided by the Library of Cochrane was used for Meta- analysis. Results A total of 7 randomized controlled trials were included. It was shown that the rehemorrhage rate of EVL was significantly lower than that of EVS （ OR = 0. 54,95% CI： 0. 38 - 0. 76, Z = 3.56, P = 0. 000 4 ） ; Meanwhile, there was no significant difference in mortality between EVL and EVS （ OR = 0. 79,95% CI：0. 55 - 1.14,Z = 1.27 ,P = 0. 21）. Compared with EVS, EVL could significantly reduce the complications of treatment （OR = 0. 22,95% CI：0. 13 -0. 38, Z = 5.51 ,P =0. 000 01 ） ; there was no significant difference in obliteration of varices between EVL and EVS （ OR = 1.46,95% CI：0. 98 - 2. 18,Z = 1.88, P = 0. 06）. Little publication bias was found with funnel plot analysis. Conclusion EVL is better than EVS in the prevention of rehemorrhagia of esophageal varices and it is the first choice for secondary prophylaxis.

关 键 词：食管静脉曲张出血 二级预防 硬化 套扎 META分析 

分 类 号：R571.3[医药卫生—消化系统]