静脉曲张套扎联合部分脾栓塞治疗肝硬化食管静脉曲张出血的META分析  

Meta Analysis of Endoscopic Variceal Ligation in Combination with Partial Splenic Embolization in Treating Esophageal Variceal Bleeding in Patients with Liver Cirrhosis

作　　者：牟东[1] 陈备金 周德江[1] 赵靖[1] 

机构地区：[1]成都军区总医院消化内科,成都610083

出　　处：《西南军医》2014年第2期121-124,共4页Journal of Military Surgeon in Southwest China

摘　　要：目的评价内镜下静脉曲张套扎（EVL）联合部分脾栓塞（PSE）治疗食管静脉曲张出血的临床疗效。方法检索PubMed、 EMBASE、 Web of Science、 The Cochrane Central Register of Controlled Trials、 Elesiver、全文数据库、中国科技期刊数据库（维普）、万方数字化期刊全文数据库、中国生物医学文献数据库等关于内镜下静脉曲张套扎联合部分脾栓塞治疗食管静脉曲张的疗效及安全性的随机对照试验（RCT），使用Rev—Man5．2版软件对纳入的研究进行Meta分析。结果共7项RCT包含428例患者符合入选标准。Meta分析结果显示：（1）EVL联合PSE患者根治率高于EVL组（RR=1．55，95％CI：1．27～1．06，P〈0．0001）；EVL联合PSE患者再出血率较EVL组明显降低（RR=0．43，95％CI：0．26～0．72，P=0．001）；EVL联合PSE患者病死率与EVL组相比差异无统计学意义（RR=0．39，95％CI：0．12～1．26，P=0．12）。（2）EVL联合PSE患者血小板计数与EvL组相比明显增高（WMD=53．85，95％CI：45．72～61．98，P〈0．00001）。结论EvL联合PSE在临床疗效及改善血小板计数明显优于EVL，但由于相关的高质量研究文献数量有限及纳入的样本量较小，尚待高质量随机对照试验证实。Objective To evaluate the clinical effect of endoscopic variceal ligation （EVL） in combination with partial splenic embolization （PSE） on esophageal variceal bleeding. Methods Retrieval was made in PubMed, EMBASE, Web of Science, The Cochrane Central Register of Controlled Trials, Elesiver, China Biology Medicine disc （CBM）,Database for Chinese Technical Periodical （VIP）, Chinese Journal Full-Text Database （CNKI）, Wan Fang Digital Journal Full-text Database to collect the randomized controlled trials （RCT） on the curative effect and safety of EVL in combination with PSE in treating esophageal varices, and Meta analysis was made with the software Review Manager 5.2. Results 7 RCT with 428 cases included met the inclusion criteria; the results of Meta analysis showed out： 1. The radical rate ofEVL in combination with PSE was higher than that in EVL group （RR=1.55 , 95%CI： 1.27-1.06,P〈 0.0001） while its re-bleeding rate was lower than that of EVL group （RR=0.43, 95%CI： 0.26-0.72, P=0.001）; the mortality of EVL in combination with PSE was of no statistical difference from that in EVL group （RR=0.39, 95%CI： 0.12-1.26, P=0.12）; 2. The platelet count of EVL in combination with PSE was much greater than that of EVL group （WMD=53.85, 95%CI： 45.72-61.98, P〈O.OOOOI）. Conclusions EVL in combination with PSE is superior in clinical curative effect and in platelet count improvement to EVL group, which needs further confirmation by RCT of high quality due to the limited number of related literature of high quality and the smaller sum of samples in this study.

关 键 词：肝硬化 静脉曲张出血 脾栓塞 静脉曲张套扎 随机对照试验 META分析 

分 类 号：R571.3[医药卫生—消化系统]