覆膜支架与裸支架TIPS比较治疗门脉高压症疗效的Meta分析  

Efficacy of PTFE-covered stent grafts versus bare stent grafts TIPS for portal hypertension:a meta-analysis

作　　者：付焱 张超 杜恩辅 李恒 

机构地区：[1]十堰市太和医院(湖北医药学院附属医院)普外科,湖北十堰442000 [2]十堰市太和医院(湖北医药学院附属医院)循证医学与临床研究中心,湖北十堰442000 [3]十堰市太和医院(湖北医药学院附属医院)影像中心,湖北十堰442000

出　　处：《中国循证医学杂志》2018年第1期35-42,共8页Chinese Journal of Evidence-based Medicine

基　　金：湖北省十堰市科技局指导项目(编号:16Y09);湖北省十堰市太和医院循证医学苗圃基金(编号:EBM2013004)

摘　　要：目的系统评价覆膜支架和裸支架经颈静脉肝内门腔静脉内支架分流术(TIPS)治疗门脉高压症的疗效。方法计算机检索PubMed、EMbase、The Cochrane Library和Clinical Trial.gov,搜集覆膜支架和裸支架比较治疗门脉高压症的随机对照试验(RCT)和队列研究,检索时限均从建库至2017年1月11日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入4个RCT和11个队列研究,包括2 422例患者,其中覆膜支架组1 070例,裸支架组1 352例。Meta分析结果显示:与裸支架组相比,覆膜支架组能明显改善肝内分流道通畅率[HR=0.38,95%CI(0.31,0.47),P<0.000 01],提高生存率[HR=0.59,95%CI(0.44,0.79),P=0.000 5],减少术后门脉高压症并发症(消化道出血、腹水)的复发率[HR=0.44,95%CI(0.33,0.58),P<0.000 01]和肝性脑病发生率[HR=0.76,95%CI(0.57,0.99),P=0.05]。结论 TIPS治疗门静脉高压症中采用覆膜支架较裸支架能增加肝内分流道通畅率,减少门脉高压症并发症和肝性脑病发生率,改善生存率。受纳入研究的数量和质量限制,上述结论尚待开展更多高质量研究予以验证。Objectives To systematically review the efficacy of polytetrafluoroethylene （PTFE） covered stent grafts vs. bare stent grafts in trans）ugular intrahepatic portosystemic shunt （TIPS） for portal hypertension. Methods PubMed, EMbase, The Cochrane Library, and ClinicalTrial.gov were searched online to collect randomized controlled trials （RCTs） and cohort studies of PTFE-covered stent grafts vs. bare stent grafts for portal hypertension from inception to Jan 11th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software. Results A total of 4 RCTs and 11 cohort studies involving 2 422 patients （1 070 PTFE-covered stent grafts patients and 1 352 bare stent grafts patients） were included. The results of meta-analysis showed that compared with the bare stent grafts group, the PTFE-covered stent grafts group had higher patency rate of intrahepatic shunt （HR=0.38, 95%CI 0.31 to 0.47, P〈0.000 01） and survival rate （HR=0.59, 95%CI 0.44 to 0.79, P=0.000 5）, lower postoperative complications rate （including gastrointestinal bleeding and refractory ascites） （HR=0.44, 95%CI 0.33 to 0.58, P〈0.000 01） and encephalopathy rate （HR=0.76, 95%CI 0.57 to 0.99, P=0.05）. Conclusions Current evidence shows that compared with the bare stent grafts, the PTFE-covered stent grafts could effectively improve patency rate of intrahepatic shunt and survival rate with less postoperative complications rate and encephalopathy rate. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

关 键 词：门脉高压 经颈静脉肝内门腔静脉内支架分流术 分流道功能障碍 肝性脑病 META分析 系统评价 随机对照试验 队列研究 

分 类 号：R544.1[医药卫生—心血管疾病]