预防肝硬化食管胃底曲张静脉再出血：经颈静脉肝内门体分流术与内镜治疗的荟萃分析

发布时间：2018-05-12 16:18

本文选题：肝硬化 + 食管胃底曲张静脉出血　；参考：《重庆医科大学》2016年硕士论文

【摘要】：目的:通过系统评价比较在预防肝硬化曲张静脉破裂再出血方面,经颈静脉肝内门体分流术(Transjugular Intrahepatic Portosystemic Shunt,TIPS)与内镜治疗(Endoscopic Therapy,ET)的临床效果。方法:通过计算机检索PubMed、Embase、Web of science、The Cochrane Library、Medline、CBM、万方、知网等数据库,根据严格纳入排除标准,将建库至2015年7月以前发表的关于预防肝硬化曲张静脉再出血的随机对照试验(Randomized controlled trial,RCT)纳入本次研究,采用Rev Man 5.2软件对纳入试验进行荟萃分析。结果:共纳入16篇高质量RCT,其中TIPS组659例,ET组644例。Meta分析结果显示:与ET相比,TIPS能更好地控制肝硬化曲张静脉再出血率及因再出血所致死亡率(RR=0.41,95%CI:0.35~0.49,P0.00001;RR=0.38,95%CI:0.24~0.59,P0.0001)。TIPS术后肝性脑病的发生率明显高于ET(RR=1.62,95%CI:1.35~1.95,P0.00001)。就总体病死率、住院总天数而言,TIPS和ET差异无统计学意义(RR=1.01,95%CI:0.83~1.23,P=0.93;MD=0.84,95%CI:-1.33~3.02,P=0.45)。结论:TIPS术后肝硬化曲张静脉再出血率低于内镜治疗,但并未改善患者总体生存率,且术后肝性脑病发生率较高。TIPS在某些情况下可作为预防肝硬化曲张静脉再出血治疗的优先选择。
[Abstract]:Objective: to evaluate and compare the clinical effects of Transjugular Intrahepatic Portosystemic shunt (TIPS) and endoscopy in the prevention of rebleeding of variceal varices in liver cirrhosis. Methods: we searched the Cochrane Library Medline (CBM), Wanfang (Wanfang), Knownet and other databases by computer, according to the criteria of strict inclusion, exclusion, and so on. A randomized controlled trial on preventing rebleeding of varicose veins in liver cirrhosis, published before July 2015, was included in this study. Rev Man 5.2 software was used to conduct a meta-analysis of the inclusion trial. Results: a total of 16 high quality RCTs were included, of which 659 cases in TIPS group and 644 cases in et group. Meta-analysis showed that tips could better control the rate of rebleeding of varicose veins in liver cirrhosis and the mortality rate caused by rebleeding in cirrhotic patients compared with et. The incidence rate was significantly higher than that of ETR RV 1.6295 and CI: 1.35 1.95% P0.00001. There was no significant difference between tips and et in terms of total hospitalization days. There was no significant difference between RRN 1.01and 95% CI: 0.83 (1.23), P0.93 (0.93%) and CI-1: -1.33 (3.02) P 0.45% (CI: -1.33) 3.02% (P = 0.45). Conclusion the rebleeding rate of varicose veins in liver cirrhosis after the operation of TIPS is lower than that of endoscopic therapy, but it does not improve the overall survival rate of the patients. The incidence of hepatic encephalopathy after operation is higher. Tips may be the first choice in the treatment of hepatic cirrhosis variceal rebleeding in some cases.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R575.2

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