Transjugular Intrahepatic Portosystemic Shunt Versus Endoscopic Therapy in the Secondary Prophylaxis of Variceal Rebleeding in Cirrhotic Patients: Meta-analysis Update
Transjugular Intrahepatic Portosystemic Shunt Versus Endoscopic Therapy in the Secondary Prophylaxis of Variceal Rebleeding in Cirrhotic Patients: Meta-analysis Update
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DOI：
10.1097/mcg.0b013e31815576e6
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发表时间：
2008-05
影响因子：
2.9
通讯作者：
M. Zheng;Yongping Chen;J. Bai;Q. Zeng;J. You;Rong Jin;Xiaoping Zhou;H. Shen;Yi Zheng
中科院分区：
文献类型：
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作者：
M. Zheng;Yongping Chen;J. Bai;Q. Zeng;J. You;Rong Jin;Xiaoping Zhou;H. Shen;Yi Zheng
目的本研究的目的是通过荟萃分析确定经颈静脉肝内门体分流术（TIPS）对减少静脉曲张再出血（VRB）的影响。背景静脉曲张出血是慢性肝病最常见和最严重的并发症之一。虽然TIPS预防性应用减少VRB的效果已经得到了评价，但TIPS对哮喘患者的有益效果仍然存在分歧。研究我们采用科克伦协作组推荐的方法对TIPS与内镜治疗预防VRB的随机对照试验（RCT）进行荟萃分析，包括在7个不同国家进行的12项RCT。结果大多数随机对照试验的质量较高。更新的荟萃分析显示，VRB发生率降低[比值比（OR）=0.32，95%置信区间（CI）]（0.24-0.43），P<0.00001]，再出血死亡[OR=0.35，95%CI（0.18-0.67），P=0.002]，治疗后脑病发生率增加[OR=2.21，95%CI（1.61-3.03），P<0.00001]与TIPS相关，而住院天数[加权平均差异=-0.21，95%CI（-3.50至3.08），P=0.90]和全因死亡[OR=1.17，95% CI（0.85-1.61），P=0.33]在2组中返回阴性结果。结论TIPS是目前预防再出血的首选方法，但TIPS对脑病的治疗效果不如内镜。探索新的治疗方法具有重要的临床意义，也是对临床医生的挑战。
Goals The aim of this study was to determine through meta-analysis the effects of transjugular intrahepatic portosystemic shunt (TIPS) for the reduction of variceal rebleeding (VRB). Background Variceal bleeding is one of the most frequent and severe complications of chronic liver disease. Although prophylactic use of TIPS for the reduction of VRB has been evaluated, the discrepancy about TIPS's beneficial effect on cirrhotic patients still exists. Study We employed the method recommended by the Cochrane Collaboration to perform a meta-analysis of randomized controlled trials (RCTs) of TIPS versus endoscopic therapy in the prevention of VRB including 12 RCTs conducted in 7 different countries. Results Most RCTs reviewed were of high quality. The updated meta-analysis showed that the decreased incidence of VRB [odds ratio (OR)=0.32, 95% confidence interval (CI) (0.24-0.43), P<0.00001], deaths due to rebleeding [OR=0.35, 95% CI (0.18-0.67), P=0.002], the increased rate of posttreatment encephalopathy [OR=2.21, 95% CI (1.61-3.03), P<0.00001] were correlated with TIPS, whereas the hospitalization days [weighted mean difference=−0.21, 95% CI (−3.50 to 3.08), P=0.90] and deaths due to all causes [OR=1.17, 95% CI (0.85-1.61), P=0.33] returned negative results in 2 groups. Conclusions TIPS is currently the first choice to prevent rebleeding except that TIPS is worse than endoscopic therapy for encephalopathy. An exploration of new approaches out of above complications will be of considerable clinical significance and be a challenge to clinicians.