经颈静脉肝内门体分流术与内镜治疗肝硬化曲张静脉再出血的Meta分析  

A Meta analysis of transjugular intrahepatic portosystemic shunt versus endoscopic therapy in the secondary prophylaxis of variceal rebleeding in patients with cirrhosis

作　　者：郭易娟 曾健[1] 梅浙川[1] 吕琳[1] 

机构地区：[1]重庆医科大学附属第二医院消化内科,400010

出　　处：《重庆医学》2016年第25期3520-3526,共7页Chongqing medicine

摘　　要：目的通过系统评价比较经颈静脉肝内门体分流术（TIPS）与内镜治疗（ET）预防肝硬化曲张静脉再出血的临床疗效。方法计算机检索PubMed、Embase、Webofscience、Cochrane Library、Medline、CBM、万方、知网等数据库，根据纳入排除标准，将建库至2015年7月以前发表的关于预防肝硬化曲张静脉再出血的随机对照试验（RCT）纳入本次研究，采用RevMan5．2软件对纳入试验进行荟萃分析。结果共纳入16篇高质量RCT，其中TIPS组659例，ET组644例。Meta分析结果表明：与ET相比，TIPS能更好地控制肝硬化曲张静脉再出血率及因再出血所致病死率（RR=0．41，95％CI：0．35～0．49，P〈0．01；RR=0．38，95％CI：0．24～0．59，P〈0．01）。TIPS术后肝性脑病的发生率明显高于ET（RR=1．62，95％CI：1．35～1．95，P〈0．01）。TIPS和ET就总体病死率、住院总天数比较，差异无统计学意义（RR=1．01，95％CI：0．83～1．23，P=0．93；MD=0．84，95％CI：-1．33～3．02，P=0．45）。结论TIPS术后肝硬化曲张静脉再出血率低于ET，但并未改善患者总体生存率，且术后肝性脑病发生率较高。TIPS在某些情况下可作为预防肝硬化曲张静脉再出血治疗的优先选择。Objective To compare the efficacy and safety of transjugular intrahepatic portosystemic shunt（TIPS） versus en- doscopic therapy（ET） in reducing variceal rebleeding in patients with cirrhosis. Methods Eligible articles published before July 2015 were identified by searches of electronic database including PubMed, Embase,Web of science, the Cochrane Library, Medline, CBM,WangFang data, CNKI. We included all randomized trials that compared TIPS versus ET for prevention of variceal rebleeding in patients with cirrhosis. Statistical analysis was performed with RevMan 5.2. Results Sixteen high quality RCTs were recruited in our study,involving 659 cases in TIPS and 644 cases in ET. The Meta-analysis showed that compared with ET,the TIPS group had a lower incidence of variceal rebleeding and deaths due to rebleeding（RR ： 0.41,95 % CI：0. 35- 0.49, P〈0. 01;RR ： 0.38, 95 %CI：0. 24--0.59, P〈0.01）. But TIPS group had an increased rate of posttreatment encephalopathy（RR： 1.62,95 ;CI：1. 35- 1.95, P〈0.01）. There were no significant differences between the tow groups as to death due to all causes and hospitalization days （RR=1.01,95;CI：0.83--1.23,P=0.93;MD=0.84,95%CI：-1. 33--3.02,P=0.45）.Conclusion In the aspect of prevention variceal rebteeding,TIPS is more effect than ET,and sometimes remains the first choice to prevent rebleeding except that TIPS is worse than ET for posttreatment encephalopathy.

关 键 词：肝硬化 食管胃底曲张静脉出血 经颈静脉肝内门体分流术 内镜治疗 

分 类 号：R575.2[医药卫生—消化系统]