内镜下套扎术与硬化剂注射术治疗食管胃底静脉曲张出血的Meta分析  

Endoscopic Variceal Ligation versus Endoscopic Injection Sclerotherapy in Treatment of Esophageal and Gastric Varices Bleeding Patients:A Meta-analysis

作　　者：柳舟[1] 张亮[2] 王璐[1] 喻淑慧 曹明为 柯全 董卫国[4] LIU Zhou;ZHANG Liang;WANG Lu;YU Shu-hui;CAO Ming-wei;KE Quan;DONG Wei-guo(Department of Intensive Care Unit,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Radiology,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Pediatric,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Gastroenterology,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院重症医学科,武汉430060 [2]武汉大学人民医院放射科,武汉430060 [3]武汉大学人民医院儿科,武汉430060 [4]武汉大学人民医院消化内科,武汉430060

出　　处：《微循环学杂志》2023年第3期46-58,共13页Chinese Journal of Microcirculation

摘　　要：目的:系统性评价内镜下套扎术(EVL)与内镜下硬化剂注射术(EIS)治疗食管胃底静脉曲张出血的安全性及有效性。方法:系统检索Pubmed、The Cochrane Library(2022年第2期)、CNKI、万方、CBM及VIP数据库,查找所有比较EVL与EIS治疗食管胃底静脉曲张出血的临床试验,检索时限为建库至2022-02-01。按照纳入及排除标准筛选文献,并采用RevMan 5.4软件进行Meta分析。结果:最终纳入46篇研究(中文20篇,英文26篇),EVL组2187例,EIS组3152例。Meta分析结果示:(1)有效性:两组患者的有效率(OR=1.07,95%CI:0.83-1.38,P=0.620)及根治率(OR=1.23,95%CI:0.97-1.54,P=0.080)差异均无统计学意义;但EVL组根治时间更短(MD=-12.44,95%CI:-21.57--3.30,P=0.008),且复发率低(OR=1.27,95%CI:1.03-1.56,P=0.020)。(2)安全性:两组患者的失败率(OR=0.93,95%CI:0.53-1.64,P=0.800)差异无统计学意义;EVL组并发症更少(OR=0.63,95%CI:0.56-0.72,P=0.000),再出血率更低(OR=0.83,95%CI:0.69-0.99,P=0.040),死亡率更低(OR=0.64,95%CI:0.50-0.83,P=0.001)。结论:EVL治疗食管胃底静脉曲张出血的有效率、根治率与EIS相当,且根治时间短、复发率低、再出血率及死亡率均低。Objective:To systematically evaluate the safety and efficacy of endoscopic variceal ligation(EVL)vs endoscopic injection sclerotherapy(EIS)for esophageal and gastric varices bleeding patients.Method:Pubmed,the Cochrane Library(Phase 2,2022),CNKI,Wangfang,CBM and VIP database were systematically searched for related clinical trials of EVL vs.EIS for esophageal and gastric varices bleeding patients.The retrieval date was from the established to February 1 st,2022.Literatures were screened according to the inclusion and exclusion criteria,and meta-analysis was performed using Revman 5.4 software.Results:A total of 46 studies were included(20 Chinese literatures and 26 English literatures),containing 2187 patients in EVL group and 3152 patients in EIS group.Meta-analysis suggested that:in terms of effectiveness,there were no significant difference in the effective rate(OR=1.07,95%CI:0.83-1.38,P=0.620)and eradication rate(OR=1.23,95%CI:0.97-1.54,P=0.080)between two groups.However,the radical cure time of EVL was shorter(MD=-12.44,95%CI:-21.57--3.30,P=0.008)and recurrent rate was relatively lower(OR=1.27,95%CI:1.03-1.56,P=0.020).In term of safety,there was no difference in the failure rate(OR=0.93,95%CI:0.53-1.64,P=0.800).Nevertheless,EVL seemed much better than EIS on complication rate(OR=0.63,95%CI:0.56-0.72,P=0.000),rebleeding rate(OR=0.83,95%CI:0.69-0.99,P=0.040)and mortality(OR=0.64,95%CI:0.50-0.83,P=0.001).Conclusion:EVL is as effective as EIS for esophageal and gastric varices bleeding patients,with the advantage of shorter radical cure time,lower recurrence rate,rebleeding rate and even mortality.

关 键 词：内镜下套扎术 内镜下硬化术 食管静脉曲张 胃底静脉曲张 META分析 

分 类 号：R571.3[医药卫生—消化系统]