TIPS联合胃冠状静脉栓塞术治疗肝硬化门静脉高压症上消化道出血的Meta分析

Meta-Analysis of the Combination of Transjugular Intrahepatic Portosystemic Shunt and Gastric Coronary Vein Embolization for Cirrhosis Portal Hypertension Associated with Upper Gastrointestinal Hemorrhage

目的对比经颈静脉肝内门体分流术(TIPS)联合胃冠状静脉栓塞术(GCVE)与单纯TIPS治疗肝硬化门静脉高压症上消化道出血(UGH)的临床疗效。方法计算机和人工检索PubMed、Cochrane Library、Web of Science、CBM、万方数据库及中国知网收录的关于比较TIPS联合GCVE与单纯TIPS治疗门静脉高压伴UGH疗效的临床对照实验的文献报道,研究者从中提取相关资料,根据Cochrane手册标准对纳入文献的质量予以评价。结果最终8篇文献纳入研究,病例总数为690例。结果显示,TIPS联合GCVE组术后再出血率及肝性脑病发生率低于单纯TIPS组(OR=0.35,95%CI:0.24～0.53,P<0.00001;OR=0.50,95%CI:0.30～0.84,P=0.009);而在支架通畅率及术后总生存率方面差异无统计学意义(OR=1.05,95%CI:0.68～1.63,P=0.83;OR=1.16,95%CI:0.74～1.80,P=0.52)。结论 TIPS联合GCVE在降低术后再出血率及肝硬化门静脉高压症术后肝性脑病发生率方面较单纯TIPS有明显优势,在提高支架通畅率及术后总生存率方面无明显差异。

Objective To compare the effectiveness of the combination of transjugular intrahepatic portosystemic shunt(TIPS) and gastric coronary vein embolization(GCVE) with that of TIPS alone for cirrhosis portal hypertension associated with upper gastrointestinal hemorrhage. Methods PubMed,Cochrane Library,Web of Science,CBM,Wan fang database and China National Knowledge Internet were used for searching literatures on the comparison of the effectiveness of the combination of TIPS and GCVE with that of TIPS alone for the treatment of cirrhosis portal hypertension associated with upper gastrointestinal hemorrhage,from which the relevant datum were extracted. The quality of the articles was assessed according to the method of Cochrane manual standard.Results : A total of eight articles were included in this Meta-analysis,covering 690 patients. Results The results of this Meta-analysis showed that the postoperative re-bleeding and hepatic encephalopathy of the combination of TIPS and GCVE was lower than that of TIPS alone(OR=0.35,95%CI:0.24-0.53,P<0.00001;OR=0.50,95%CI:0.30-0.84,P=0.009). However,there were no statistical significance between the two groups in the incidence of patency rate of stent and total mortality(OR=1.05,95%CI:0.68-1.63,P=0.83;OR=1.16,95%CI:0.74-1.80,P=0.52). Conclusion Compared with TIPS alone,the combination of TIPS and GCVE has obvious advantages with reducing the rate of postoperative re-bleeding and hepatic encephalopathy,without improving the rate of patency of stent and total mortality.