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覆膜支架与裸支架对经颈静脉肝内门体分流术远期疗效影响的Meta分析
Influence of covered stent versus bare stent on long-term efficacy of transjugular intrahepatic portosystemic shunt: a meta-analysis
文章发布日期:2016年09月07日  来源:  作者:徐璐,肖雪,刘景琪,等  点击次数:1149次  下载次数:217次

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【摘要】:目的通过比较经颈静脉肝内门体分流术(TIPS)中应用聚四氟乙烯(PTFE)覆膜支架与裸支架的术后远期疗效,为TIPS的支架选择提供循证医学依据。方法检索中国生物医学文献数据库、万方数据库、中国知网、维普数据库、Medline、PubMed中1989-2015年发表的有关TIPS治疗肝硬化门静脉高压的对照试验,选取符合纳入标准的研究并对文献进行质量评价。采用RevMan5.3软件对TIPS治疗后支架功能障碍发生率、肝性脑病发病率及1年生存率进行分析,发表偏倚采用漏斗图进行评估。结果共纳入11项研究,包括PTFE覆膜支架组698例及裸支架组1283例患者。Meta分析结果显示,PTFE覆膜支架组的支架功能障碍发生率(14.8%)低于裸支架组(47.0%),差异有统计学意义[比值比(OR)=0.18,95%可信区间(95%CI):0.13~0.24,P<0001];2组肝性脑病发病率差异无统计学意义(23.5% vs 25.7%,OR=0.88,95%CI:0.66~1.17,P=0.37);PTFE覆膜支架组患者术后1年生存率(76.9%)高于裸支架组(62.7%),差异有统计学意义(OR=2.10,95%CI:1.54~2.85,P<0.001)。基于支架功能障碍发生率、肝性脑病发病率、术后1年生存率绘制的漏斗图分布欠对称,提示可能存在一定的发表偏倚。结论应用PTFE覆膜支架较裸支架可改善TIPS治疗后支架功能障碍,提高患者术后1年生存率,但不会影响肝性脑病发病率,故PTFE覆膜支架在TIPS手术中的应用较裸支架具有一定优势。
【Abstract】:ObjectiveTo investigate the long-term postoperative efficacy of transjugular intrahepatic portosystemic shunt (TIPS) using polytetrafluoroethylene (PTFE)-covered stent or bare stent, and to provide a basis of evidence-based medicine for the selection of stent in TIPS. Methods CBM, Wanfang Data, CNKI, VIP, MEDLINE, and PubMed were searched for controlled trials on TIPS in the treatment of cirrhotic portal hypertension published form 1989 to 2015; the studies which met the inclusion criteria were selected, and quality assessment was performed for these articles. RevMan 5.3 software was used to analyze the incidence rates of stent dysfunction and hepatic encephalopathy and 1-year survival rate after TIPS, and funnel plots were used to analyze publication bias. Results A total of 11 studies were included, consisting of 698 patients in PTFE-covered stent group and 1283 patients in bare stent group. The results of the meta-analysis showed that the PTFE-covered stent group showed a significantly lower incidence rate of stent dysfunction than the bare stent group (148% vs 47.0%, OR=0.18, 95% CI: 0.13-0.24, P<0.001). There was no significant difference in the incidence rate of hepatic encephalopathy between the two groups (23.5% vs 25.7%, OR=0.88, 95% CI: 0.66-1.17, P=0.37). The PTFE-covered stent group had a significantly higher 1-year survival rate than the bare stent group (76.9% vs 62.7%, OR=2.10, 95% CI: 1.54-2.85, P<0.001). The funnel plots which were plotted based on the incidence rates of stent dysfunction and hepatic encephalopathy and 1-year survival rate lacked symmetry, which suggested that a certain degree of publication bias might exist. ConclusionCompared with the bare stent, the PTFE-covered stent can improve stent dysfunction and 1-year survival rate after TIPS, while there is no significant change in the incidence rate of hepatic encephalopathy. Therefore, the PTFE-covered stent has certain advantages over the bare stent in TIPS. In future, multicenter prospective randomized controlled clinical trials with a larger sample size are needed to provide a basis of evidence-based medicine for the application of covered stent in TIPS.
【关键字】:高血压, 门静脉; 门体分流术, 经颈静脉肝内; 支架; Meta分析
【Key words】:hypertension, portal; portasystemic shunt, transjugular intrahepatic; stents; Meta-analysis
【引证本文】:徐璐, 肖雪, 刘景琪, 等. 覆膜支架与裸支架对经颈静脉肝内门体分流术远期疗效影响的Meta分析[J]. 临床肝胆病杂志, 2016, 32(10): 1900-1905.

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