TIPS对比EBL治疗肝硬化食管静脉曲张出血Meta分析

The treatment of cirrhosis esophageal variceal bleeding:a meta-analysis of TIPS versus EBL

目的系统评价经颈静脉肝内门体分流术(TIPS)对比内镜下套扎术(EBL)治疗肝硬化食管静脉曲张出血。方法检索Pub Med、EMbase、Cochrane、中国知网和中国万方等数据库中TIPS对比EBL治疗肝硬化食管静脉曲张出血的随机对照试验研究文献,检索时限均自建库至2015年11月,并追溯各文献中参考文献。2名研究员按照纳入与排除标准独立筛选文献、提取资料并评价质量,采用Rev Man 5.3软件作统计学分析。结果最终6篇文献纳入研究,总病例数413例。Mata分析结果显示,TIPS术后肝性脑病发生率与EBL相比,差异无统计学意义(OR=1.16,95%CI 0.71、1.88,P=0.55);TIPS术后再出血发生率低于EBL,差异有统计学意义(OR=0.23,95%CI 0.11、0.50,P=0.0002);两者间总死亡率差异无统计学意义(OR=0.76,95%CI 0.50、1.17,P=0.21),但亚组2 TIPS总死亡率(23%)低于EBL组(43%)。结论 TIPS术后肝性脑病发生率高达24%,与EBL相比差异虽无统计学意义,但应予以重视。TIPS与EBL相比可更好地控制食管静脉曲张出血。非早期TIPS治疗肝硬化食管静脉曲张出血与EBL相比总死亡率相同,但早期TIPS治疗可降低总死亡率。

Objective To systematically evaluate transjugular intrahepatic portosystemic shunt （TIPS） and endoscopic band ligation （EBL） in treating cirrhosis esophageal variceal bleeding. Methods The randomized controlled trials concerning TIPS and EBL treatment for cirrhosis esophageal variceal bleeding were searched from database, including PubMed, EMbase, Cochrane, China National Knowledge Internet （CNKI） and Wanfang Data, the retrieval time was from the establishment of database to November 2015, and the references in the literature were traced back. According to the inclusion and exclusion criteria, the selected scientific studies were separately screened by two researchers. The data were extracted and evaluated. RevMan 5.3 software was used to make statistical analysis. Results A total of 6 randomized controlled trials were finally enrolled in this study, a total of 413 patients were included. Meta-analysis showed that no statistically significant difference in the occurrence of postoperative hepatic eneephalopathy existed between TIPS and EBL （0R=1.16,95%~7：0.71-1.88, P=0.55）. The postoperative re-bleeding rate of TIPS was lower than that of EBL, and the difference was statistically significant （0R=0.23, 95%CI：0.11-0.50, P=0.000 2）. The difference in the total mortality between TIPS and EBL was not statistically significant （OR=0.76, 95% CI：0.50-1.17, P=0.21）, although in sub-group II , the total mortality of TIPS group was 23%, which was strikingly lower than 43% of EBL group. Conclusion The incidence rate of hepatic encephalopathy afterTIPS treatment can be as high as 24%, to which attention should be paid, although it has no statistical significance when compared with the incidence rate of hepatic encephalopathy after EBL treatment. Compared with EBL, TIPS can control the esophageal variceal bleeding more effectively. Non-early TIPS treatment of cirrhosis esophageal yariceal bleeding carries the same total mortality as EBL treatment does, but early TIPS treatment can reduce the total mortality.