摘要
目的荟萃分析肝硬化患者在经颈静脉肝内门-体静脉分流术(TIPS)期间使用8 mm和10 mm直径覆膜支架在临床结局方面的差异。方法系统检索PubMed、EMBASE和Cochrane-Library数据库中的相关文献,检索时限为建库至2020年3月31日,预先设计数据提取表,并评估纳入研究的质量,通过Cochran Q统计量检验,I2检验和亚组分析进行异质性评估。结果筛选出5项合格研究,共纳入489例患者(55.4%的患者置入8 mm直径支架,44.6%的患者置入10 mm直径支架)。在降低肝性脑病(HE)发生率方面,8 mm支架优于10 mm支架(OR=0.64;95%CI 0.44~0.93,P=0.02,I2=0);分流道功能障碍的发生率方面,8 mm支架与10 mm支架无显著差异(OR=1.11;95%CI 0.66~1.86,P=0.70,I2=0);术后1年生存率8 mm支架优于10 mm支架(OR=2.33;95%CI 1.25~4.34,P=0.008,I2=0)且8 mm支架能提高患者总体生存率(HR=0.56;95%CI 0.32~0.97,P=0.04,I2=0)。结论 8 mm支架较10 mm支架术后HE的发生率更低,且能提高患者术后生存率,两组患者术后分流道功能无显著差异。
Objective This systematic review and Meta-analysis aims to explore the differences in clinical outcomes between 8 mm and 10 mm diameter stents during TIPS for patients with cirrhosis. Methods Systematic search of Pubmed, EMBASE,and Cochrane Library databases for related clincialtrials(Until March 31, 2020).The incidence of hepatic encephalopathy, stent patency rate and survival rate after TIPS were reported. We designed the data extraction table in advance and evaluated the quality of the included studies.The analyses based on random-effects/Fixed-effectmodels. Heterogeneity assessment by Cochran’s Q,I2 statistic,subgroupanalyses,and Meta-regression. Results Five studies were eligible. A total of 489 patients( 55. 4% patients implanted 8 mm diameter stent,the rest for 10 mm diameter stent were included). 8 mm-stents were superior to 10 mm-stent in decreasing the incidence of hepatic encephalopathy( OR = 0. 64;95% CI,0. 44-0. 93,P = 0. 02,I2= 0). There was no significant difference in the incidence of shunt loss between 8 mm stent and10 mm stent( OR = 1. 11;95% CI,0. 66-1. 86,P = 0. 70,I2= 0). The 1-year survival rate of 8 mm stent was better than that of 10 mm stent( OR = 2. 33;95% CI,1. 25-4. 34,P = 0. 008,I2= 0),and 8 mm stent can improve the overall survival rate of patients( HR = 0. 56;95% CI,0. 32-0. 97,P = 0. 04,I2= 0). Conclusion 8 mm stents had a lower incidence of HE compared to 10 mm stents,and could improve the overall survival rate of patients,with no significant difference in postoperative shunt function.
作者
周林峰
罗成刚
张勇
陶钧
李子林
朱晓黎
ZHOU Linfeng;LUO Chenggang;ZHANG Yong(Department of Radiology,Hubei Cancer Hospital,Wuhan,Hubei Province 430070,P.R.China)
出处
《临床放射学杂志》
北大核心
2021年第5期997-1002,共6页
Journal of Clinical Radiology
