经皮经肝胃冠状静脉栓塞术单独或联合部分脾动脉栓塞术治疗肝硬化门静脉高压出血效果比较的Meta分析  

Efficacy of percutaneous transhepatic variceal embolization alone or in combination with partial splenic embolization in treatment of portal hypertensive hemorrhage in liver cirrhosis:A Meta-analysis

作　　者：朱军源 夏翊夫 杜艳梅 张春清 ZHU Junyuan;XIA Yifu;DU Yanmei;ZHANG Chunqing(Department of Gastroenterology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Graduate Division of Shandong First Medical University(Shandong Academy of Medical Sciences),Jinan 250117,China)

机构地区：[1]山东第一医科大学附属省立医院消化内科,济南250021 [2]山东第一医科大学(山东省医学科学院)研究生部,济南250117

出　　处：《临床肝胆病杂志》2024年第1期89-95,共7页Journal of Clinical Hepatology

基　　金：国家自然科学基金(81970533,81770606)。

摘　　要：目的采用Meta分析对比经皮经肝胃冠状静脉栓塞术(PTVE)联合部分脾动脉栓塞术(PSE)与单独PTVE治疗肝硬化门静脉高压出血的疗效。方法本研究根据PRISMA指南完成,PROSPERO注册号:CRD42023396690。检索万方医学网、中国知网、中国生物医学文献数据库、维普数据库、PubMed、Embase、Cochrane Library、Web of Science自建库至2022年12月23日有关对比PTVE联合PSE与单独PTVE两种手术方式治疗肝硬化门静脉高压出血的相关文献;依据纳入及排除标准筛选文献,并提取相关数据,采用RevMan 5.4.1统计分析软件进行Meta分析。结果最终纳入文献8篇,总样本量为592例,包括PTVE联合PSE组316例,单独PTVE组276例。Meta分析结果显示,PTVE联合PSE组术后门静脉压力(SMD=-1.75,95%CI:-2.33~-1.16,P<0.05)、术后门静脉内径(SMD=-0.87,95%CI:-1.64~-0.10,P<0.05)、术后再出血率(OR=0.17,95%CI:0.11~0.28,P<0.05)、病死率(OR=0.13,95%CI:0.04~0.37,P<0.05)、术后门静脉高压性胃肠病发生率(OR=0.17,95%CI:0.07~0.45,P<0.05)均低于单独PTVE组;术后血小板水平(SMD=0.79,95%CI:0.52~1.06,P<0.05)高于单独PTVE组。结论PTVE联合PSE较单独PTVE可有效降低肝硬化门静脉高压再出血率、病死率、门静脉高压性胃肠病发生率、门静脉压力,缩短门静脉内径,提高血小板水平,是治疗肝硬化门静脉高压出血的有效介入手段。Objective To investigate the efficacy of percutaneous transhepatic variceal embolization(PTVE)alone or in combination with partial splenic embolization(PSE)in the treatment of portal hypertensive hemorrhage in liver cirrhosis through a meta-analysis.Methods This study was conducted according to PRISMA guideline,with a PROSPERO registration number of CRD42023396690.Wanfang Med Online,CNKI,CBM,VIP Databases,PubMed,Embase,the Cochrane Library,and Web of Science databases were searched for articles on PTVE alone or in combination with PSE in the treatment of portal hypertensive hemorrhage in liver cirrhosis published up to December 23,2022.The articles were selected based on inclusion and exclusion criteria,and related data were extracted.The RevMan 5.4.1 statistical analysis software was used to perform the meta-analysis.Results Eight articles were finally included,with a total sample size of 592 cases,among which there were 316 cases in the PTVE+PSE group and 276 cases in the PTVE group.The meta-analysis showed that compared with the PTVE group,the PTVE+PSE group had significantly lower postoperative portal vein pressure(standardized mean difference[SMD]=−1.75,95%confidence interval[CI]:−2.33 to−1.16,P<0.05),postoperative diameter of the portal vein(SMD=−0.87,95%CI:−1.64 to−0.10,P<0.05),postoperative rebleeding rate(odds ratio[OR]=0.17,95%CI:0.11-0.28,P<0.05),mortality rate(OR=0.13,95%CI:0.04-0.37,P<0.05),and incidence rate of postoperative portal hypertensive gastrointestinal disease(OR=0.17,95%CI:0.07-0.45,P<0.05),as well as a significantly higher postoperative platelet level(SMD=0.79,95%CI:0.52-1.06,P<0.05),while there were no significant differences between the two groups in the incidence rates of postoperative ascites.Conclusion Compared with PTVE alone,PTVE combined with PSE can effectively reduce the rebleeding rate and mortality rate of portal hypertensive hemorrhage in liver cirrhosis,the incidence rate of portal hypertensive gastrointestinal disease,and portal vein pressure,and it can also sho

关 键 词：肝硬化 高血压 门静脉 出血 治疗结果 META分析 

分 类 号：R657.3[医药卫生—外科学]