摘要
AIM:To assess the effectiveness of transjugular intrahepatic portosystemic stent shunt(TIPSS) in refractory hepatic hydrothorax(RHH) in a systematic review and cumulative meta-analysis.METHODS:A comprehensive literature search was conducted on MEDLINE,EMBASE,and Pub Med covering the period from January 1970 to August 2014.Two authors independently selected and abstracted data from eligible studies.Data were summarized using a random-effects model.Heterogeneity was assessed using the I2 test.RESULTS:Six studies involving a total of 198 patients were included in the analysis.The mean(SD) age of patients was 56(1.8) years.Most patients(56.9%) had Child-Turcott-Pugh class C disease.The mean duration of follow-up was 10 mo(range,5.7-16 mo).Response to TIPSS was complete in 55.8%(95%CI:44.7%-66.9%),partial in 17.6%(95%CI:10.9%-24.2%),and absent in 21.2%(95%CI:14.2%-28.3%).The mean change in hepatic venous pressure gradient post-TIPSS was 12.7 mm Hg.The incidence of TIPSS-related encephalopathy was 11.7%(95%CI:6.3%-17.2%),and the 45-d mortality was 17.7%(95%CI:11.34%-24.13%).CONCLUSION:TIPSS is associated with a clinically relevant response in RHH.TIPSS should be considered early in these patients,given its poor prognosis.
AIM To assess the effectiveness of transjugularintrahepatic portosystemic stent shunt （TIPSS） inrefractory hepatic hydrothorax （RHH） in a systematicreview and cumulative meta-analysis.METHODS： A comprehensive literature searchwas conducted on MEDLINE, EMBASE, and PubMedcovering the period from January 1970 to August 2014.Two authors independently selected and abstracteddata from eligible studies. Data were summarized usinga random-effects model. Heterogeneity was assessedusing the I 2 test.RESULTS： Six studies involving a total of 198 patientswere included in the analysis. The mean （SD） age ofpatients was 56 （1.8） years. Most patients （56.9%） hadChild-Turcott-Pugh class C disease. The mean duration offollow-up was 10 mo （range, 5.7-16 mo）. Response toTIPSS was complete in 55.8% （95%CI： 44.7%-66.9%）,partial in 17.6% （95%CI： 10.9%-24.2%）, and absentin 21.2% （95%CI： 14.2%-28.3%）. The mean change inhepatic venous pressure gradient post-TIPSS was 12.7mmHg. The incidence of TIPSS-related encephalopathywas 11.7% （95%CI： 6.3%-17.2%）, and the 45-dmortality was 17.7% （95%CI： 11.34%-24.13%）.CONCLUSION： TIPSS is associated with a clinicallyrelevant response in RHH. TIPSS should be consideredearly in these patients, given its poor prognosis.
