对比TIPS联合胃冠状静脉栓塞术与单独TIPS治疗肝硬化门静脉高压伴上消化道出血的中远期疗效:Meta分析  

Comparison on medium and long term efficacy of TIPS combined with gastric coronary vein embolization and TIPS alone for treating cirrhotic portal hypertension with upper gastrointestinal hemorrhage:Meta-analysis

作　　者：高绍 王宏亮 聂春晖[1] 张岳林[1] 周坦洋[1] 余子牛[1] 杨月 孙军辉[1] GAO Shao;WANG Hongliang;NIE Chunhui;ZHANG Yuelin;ZHOU Tanyang;YU Ziniu;YANG Yue;SUN Junhui(Hepatobiliary and Pancreatic Intervention Center,Zhejiang Clinical Medical Research Center for Hepatobiliary and Pancreatic Diseases,Zhejiang Research Center for Diagnosis and Treatment Technology of Severe Hepatobiliary Diseases,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Radiology,Affiliated Hospital of Shaoxing University,Shaoxing 312000,China)

机构地区：[1]浙江大学医学院附属第一医院肝胆胰介入中心,浙江省肝胆胰疾病临床医学研究中心,浙江省重症肝胆疾病(移植)诊治技术研究中心,浙江杭州310003 [2]绍兴文理学院附属医院放射科,浙江绍兴312000

出　　处：《中国介入影像与治疗学》2022年第11期673-677,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：国家自然科学基金面上项目(81971713)。

摘　　要：目的采用meta分析方法对比TIPS联合胃冠状静脉栓塞术(GCVE)与单独TIPS治疗肝硬化门静脉高压(PTH)上消化道出血(UGH)的中远期疗效。方法检索中国知网、万方医学网、中国生物医学文献数据库、维普数据库、PubMed、Embase、Cochrane Library、Web of Science数据库自建立至2021年12月31日有关对比TIPS联合GCVE(试验组)与单独TIPS(对照组)治疗肝硬化PTH伴UGH疗效的相关文献;依据纳入及排除标准筛选文献,并提取相关数据,采用RevMan 5.3及Stata 14.0软件进行meta分析。结果最终纳入文献17篇,总样本量为1486例,包括试验组803例、对照组683例。meta分析结果显示,试验组治疗后6~12个月再次出血率[RR=0.32,95%CI(0.24,0.42),P<0.00001]、支架闭塞或狭窄率[RR=0.59,95%CI(0.39,0.89),P=0.01]及肝性脑病发生率[RR=0.54,95%CI(0.40,0.75),P=0.002]均低于对照组。结论TIPS联合GCVE可有效降低肝硬化PHT伴UGH患者中远期再次出血率、支架闭塞或狭窄率及肝性脑病发生率。Objective To compare the medium and long term efficacy of TIPS combined with gastric coronary vein embolization(GCVE)and TIPS alone for treating cirrhotic portal hypertension(PTH)with upper gastrointestinal hemorrhage(UGH)using meta-analysis.Methods Published literature about comparison on efficacy of TIPS combined with GCVE(experimental group)and TIPS alone(control group)for treating cirrhotic PTH with UGH were searched in CNKI,Wanfang Med Online,CBMdisc,VIP databases,PubMed,Embase,Cochrane Library and Web of Science from database establishment to December 31,2021.Then the literatures were screened according to inclusion and exclusion criteria,and relevant data were extracted.RevMan 5.3 and Stata 14.0 software were used for meta-analysis.Results Seventeen articles were included,with a total of 1486 cases,803 cases in experimental group and 683 cases in control group.Meta-analysis showed that 6-12 months after operation,the rate of rebleeding(RR=0.32,95%CI[0.24,0.42],P<0.00001),stent occlusion or stenosis(RR=0.59,95%CI[0.39,0.89],P=0.01)and hepatic encephalopathy(RR=0.54,95%CI[0.40,0.75],P=0.002)in experimental group were all lower than those in control group.Conclusion TIPS combined with GCVE had obvious advantages for reducing the incidence of medium and long term postoperative rebleeding,stent occlusion or stenosis and hepatic encephalopathy in cirrhotic PTH patients with UGH.

关 键 词：肝硬化 高血压 门静脉 出血 门体分流术 经颈静脉肝内 栓塞 治疗性 荟萃分析 

分 类 号：R573.2[医药卫生—消化系统] R815[医药卫生—内科学]