内镜下套扎术与腔内外联合断流术治疗食管静脉曲张的Meta分析

发布时间：2018-02-24 05:46

本文关键词： 食管和胃静脉曲张结扎术断流术 Meta分析　出处：《中国现代手术学杂志》2015年03期 　论文类型：期刊论文

【摘要】：目的比较内镜下套扎(endoscopic variceal ligation,EVL)与腔内外联合断流术对肝硬化食管静脉曲张的疗效。方法检索中国知网全文数据库、万方数据库、中国生物医学文献数据库和美国国立医学图书馆网站Pub Med,查阅1998年~2013年发表的有关EVL和腔内外联合断流术治疗肝硬化食管静脉曲张的随机对照临床试验文献。采用Rev Man 5.2进行Meta分析。结果共5项前瞻性随机对照试验纳入研究,共纳入患者480例,其中行EVL 260例,行联合断流220例。Meta分析结果显示,联合断流术治疗的食管静脉曲张复发率低于EVL,RR=7.34(95%CI=4.30~12.51,P0.00001),再出血率低于EVL,RR=6.24(95%CI=3.19~12.18,P0.00001),但并发症率高于EVL,RR=0.15(95%CI=0.07~0.33,P0.00001),而两组死亡率比较差异无统计学意义,RR=1.65(95%CI=0.68~4.01,P=0.27)。结论食管腔内外联合断流术与单纯EVL相比,并不增加患者死亡率,术后食管静脉曲张复发率、上消化道再出血发生率低,远期疗效优于EVL,但其术后并发症发生率高于EVL。对于手术方式的选择,应结合病人实际的状态,如肝脏功能较差,应选择微创、短期有效的EVL;若肝脏功能较好,可以考虑进行食管腔内外联合断流治疗,争取长期避免出血的风险。
[Abstract]:Objective to compare the efficacy of endoscopic variceal ligation (EVLV) and intracavitary combined devascularization in the treatment of esophageal varices due to cirrhosis. The Chinese Biomedical Literature Database and Pub Med, a Web site of the National Library of Medicine of the United States of America, were reviewed for the randomized controlled clinical trials on the treatment of esophageal varices due to cirrhosis by EVL and combined intracavitary and intracavitary devascularization from 1998 to 2013. Meta analysis was performed with Rev Man 5.2. Results A total of 5 prospective randomized controlled trials were included in the study. A total of 480 patients were included, of whom 260 were treated with EVL, and 220 were treated with combined disconnection. The results of meta-analysis showed that, The recurrence rate of esophageal varices treated by combined devascularization was lower than that of EVLRRR 7.3495 CIQ 4.30 ~ 12.51g P 0.00001, and the rate of rebleeding was lower than that of EVLR RRN 6.2495CIQ 3.1912.18CII P0.00001, but the complication rate was higher than that of EVLRR0.1595 CIV 0.0333P0.00001, but there was no significant difference in mortality between the two groups. Conclusion compared with EVL alone, the mortality of the two groups is not significantly higher than that of EVLR 1.65CI0.684.01P0 0.270.Conclusion compared with EVL alone, the incidence of esophageal varicose recrudescence is higher than that of EVLRR 7.3495. The mortality rate was not increased, the recurrence rate of esophageal varices, the recurrence rate of upper gastrointestinal tract rebleeding was low, the long-term effect was better than that of EVLL, but the incidence of postoperative complications was higher than that of EVL. If liver function is poor, minimally invasive and effective EVLs should be selected, and if liver function is good, we can consider combined treatment of esophageal and extravascular disconnection to avoid the risk of bleeding in the long term.
【作者单位】：吉林大学中日联谊医院胃肠外科;
【分类号】：R657.34

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