应用明胶海绵与聚乙烯醇颗粒行部分脾栓塞治疗肝硬化脾亢的Meta分析  

Partial splenic embolization using polyvinyl alcohol and gelfoam to treat hypersplenism in cirrhotic patients： a Meta-analysis

作　　者：俞亮[1] 潘飞[1] 张涛[1] 贺强[1] 郎韧[1] 吴天鸣[1] Yu Liang Pan Fei Zhang Tao He Qiang Lang Ren Wu Tianming.(Department of Hepatobiliary Surgery, the Chaoyang Hospital of Capital Medical University, Beijing 100020, China)

机构地区：[1]首都医科大学朝阳医院肝胆外科,北京100020

出　　处：《中华肝胆外科杂志》2016年第12期827-831,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的评价明胶海绵与聚乙烯醇（PVA）颗粒作为部分脾栓塞材料治疗肝硬化脾亢的安全性和疗效。方法计算机检索PubMed、Embase、TheChranelibrary、中国生物医学文献数据库、中国知网、万方数据及维普医药数据库，纳入所有使用PVA颗粒与明胶海绵行部分脾栓塞术治疗肝硬化脾亢的对照试验，检索时限截至2016年5月。将符合标准的文献纳入后进行质量评价与数据提取，使用RevMan5．3软件进行Mem分析。结果共纳入5篇研究、197例患者，其中PVA组92例，明胶海绵组105例。Meta分析显示：PVA组术后1个月WBC（WMD=0．4，95％CI：0．05～0．75，P〈0．05）、术后6个月的WBC水平（WMD=0．39，95％CI：O．06～0．71，P〈0．05）以及术后6个月PLT水平（WMD=8．08，95％C1：1．65～14．51，P〈0．05）均高于明胶海绵组。PVA组术后Ⅱ度以上疼痛的发生率较高（RR=1．32，95％CI：1．14～1．54，P〈0．05）、术后疼痛持续时间较长（RR=2．01，95％C1：1．36～2．66，P〈0．05）。二者在术后1个月PLT水平、术后发热和并发症方面差异无统计学意义（均P〉0．05）。结论对于肝硬化脾亢患者，选用PVA颗粒行部分脾栓塞术，在改善血液学指标方面的近、远期疗效优于明胶海绵，但也增加了患者术后疼痛的程度和持续时间。Objective To evaluate the effectiveness and safety of partial splenic embolization using polyvinyl alcohol versus gelfoam to treat hypersplenism in cirrhotic patients. Methods A literature search was performed in databases which included PubMed, Embase, Cochrane hbrary, Sinomed, CNKI, Wang- fang data and VIP for trials on partial splenic embolism using PVA or gelfoam to treat hypersplenism in cir- rhotic patients. The study was censored in May 2016. After data extraction and assessment of quality, a me- ta-analysis was performed using the RevMan 5.3 software. Results Five studies which involved 197 pa- tients were selected in this study. Included into the PVA group were 92 patients and the gelfoam group 105 patients. On Meta-analysis, the PVA group had a higher value of WBC a month after PSE （ WMD = O. 4, 95% CI： 0. 05 - 0. 75, P 〈 0. 05 ）, higher values of WBC （ WMD = 0. 39, 95% CI： 0. 06 - 0. 71, P 〈 0. 05 ） and PLT （ WMD = 8.08, 95% CI： 1.65 - 14. 51, P 〈0.05 ） on month 6 post-embolizatiom The de- gree of post-embolization pain was more severe （RR = 1.32, 95% CI： 1. 14 - 1.54, P 〈0. 05） and the length of painful time was longer （RR = 2.01, 95% CI： 1.36 - 2. 66, P 〈 0.05） in the PVA group. There were no significant differences in the values of PLT, fever and complications （ all P 〉 0.05 ）. Condusions PSE using PVA achieved better short-term and long-term results in hematological indicators than gelfoam. However, the degree and extent of duration of pain were significantly longer.

关 键 词：部分脾栓塞 聚乙烯醇 明胶海绵 肝硬化 脾功能亢进 

分 类 号：R575.2[医药卫生—消化系统]