经皮经肝胃冠状静脉栓塞术单独或联合部分脾动脉栓塞术治疗肝硬化门静脉高压出血效果比较的Meta分析

朱军源; 夏翊夫; 杜艳梅; 张春清

doi:10.12449/JCH240116

经皮经肝胃冠状静脉栓塞术单独或联合部分脾动脉栓塞术治疗肝硬化门静脉高压出血效果比较的Meta分析

DOI: 10.12449/JCH240116

1.
山东第一医科大学附属省立医院消化内科，济南 250021
2.
山东第一医科大学（山东省医学科学院）研究生部，济南 250117

基金项目:

国家自然科学基金 (81970533);

国家自然科学基金 (81770606)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：朱军源负责查阅国内外文献，筛选文献，数据分析并撰写论文；夏翊夫负责指导论文撰写和审校；杜艳梅负责筛选文献，数据分析；张春清负责指导论文撰写，审校并最后定稿。

详细信息

通信作者:
张春清， 13583188661@163. com （ORCID： 0000-0001-8711-1579）

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出版历程
- 收稿日期: 2023-04-02
- 录用日期: 2023-05-15
- 出版日期: 2024-01-23

Efficacy of percutaneous transhepatic variceal embolization alone or in combination with partial splenic embolization in treatment of portal hypertensive hemorrhage in liver cirrhosis： A Meta-analysis

1.
Department of Gastroenterology，Shandong Provincial Hospital Affiliated to Shandong First Medical University，Jinan 250021，China
2.
Graduate Division of Shandong First Medical University （Shandong Academy of Medical Sciences），Jinan 250117，China

Research funding:

National Natural Science Foundation of China (81970533);

National Natural Science Foundation of China (81770606)

More Information

Corresponding author: ZHANG Chunqing， 13583188661@163.com （ORCID： 0000-0001-8711-1579）

摘要

摘要: 目的采用Meta分析对比经皮经肝胃冠状静脉栓塞术（PTVE）联合部分脾动脉栓塞术（PSE）与单独PTVE治疗肝硬化门静脉高压出血的疗效。方法本研究根据PRISMA指南完成，PROSPERO注册号：CRD42023396690。检索万方医学网、中国知网、中国生物医学文献数据库、维普数据库、PubMed、Embase、Cochrane Library、Web of Science自建库至2022年12月23日有关对比PTVE联合PSE与单独PTVE两种手术方式治疗肝硬化门静脉高压出血的相关文献；依据纳入及排除标准筛选文献，并提取相关数据，采用RevMan 5.4.1统计分析软件进行Meta分析。结果最终纳入文献8篇，总样本量为592例，包括PTVE联合PSE组316例，单独PTVE组276例。Meta分析结果显示，PTVE联合PSE组术后门静脉压力（SMD=-1.75，95%CI：-2.33～-1.16，P<0.05）、术后门静脉内径（SMD=-0.87，95%CI：-1.64～-0.10，P<0.05）、术后再出血率（OR=0.17，95%CI：0.11～0.28，P<0.05）、病死率（OR=0.13，95%CI：0.04～0.37，P<0.05）、术后门静脉高压性胃肠病发生率（OR=0.17，95%CI：0.07～0.45，P<0.05）均低于单独PTVE组；术后血小板水平（SMD=0.79，95%CI：0.52～1.06，P<0.05）高于单独PTVE组。结论 PTVE联合PSE较单独PTVE可有效降低肝硬化门静脉高压再出血率、病死率、门静脉高压性胃肠病发生率、门静脉压力，缩短门静脉内径，提高血小板水平，是治疗肝硬化门静脉高压出血的有效介入手段。
- 肝硬化 /
- 高血压，门静脉 /
- 出血 /
- 治疗结果 /
- Meta分析
Abstract: Objective To investigate the efficacy of percutaneous transhepatic variceal embolization （PTVE） alone or in combination with partial splenic embolization （PSE） in the treatment of portal hypertensive hemorrhage in liver cirrhosis through a meta-analysis. Methods This study was conducted according to PRISMA guideline， with a PROSPERO registration number of CRD42023396690. Wanfang Med Online， CNKI， CBM， VIP Databases， PubMed， Embase， the Cochrane Library， and Web of Science databases were searched for articles on PTVE alone or in combination with PSE in the treatment of portal hypertensive hemorrhage in liver cirrhosis published up to December 23， 2022. The articles were selected based on inclusion and exclusion criteria， and related data were extracted. The RevMan 5.4.1 statistical analysis software was used to perform the meta-analysis. Results Eight articles were finally included， with a total sample size of 592 cases， among which there were 316 cases in the PTVE+PSE group and 276 cases in the PTVE group. The meta-analysis showed that compared with the PTVE group， the PTVE+PSE group had significantly lower postoperative portal vein pressure （standardized mean difference ［SMD］=-1.75， 95% confidence interval ［CI］： -2.33 to -1.16， P<0.05）， postoperative diameter of the portal vein （SMD=-0.87， 95%CI： -1.64 to -0.10， P<0.05）， postoperative rebleeding rate （odds ratio ［OR］=0.17， 95%CI： 0.11 — 0.28， P<0.05）， mortality rate （OR=0.13， 95%CI： 0.04 — 0.37， P<0.05）， and incidence rate of postoperative portal hypertensive gastrointestinal disease （OR=0.17， 95%CI： 0.07 — 0.45， P<0.05］， as well as a significantly higher postoperative platelet level （SMD=0.79， 95%CI： 0.52 — 1.06， P<0.05）， while there were no significant differences between the two groups in the incidence rates of postoperative ascites. Conclusion Compared with PTVE alone， PTVE combined with PSE can effectively reduce the rebleeding rate and mortality rate of portal hypertensive hemorrhage in liver cirrhosis， the incidence rate of portal hypertensive gastrointestinal disease， and portal vein pressure， and it can also shorten the diameter of the portal vein and increase platelet level. Therefore， it is an effective interventional method for the treatment of portal hypertension hemorrhage in liver cirrhosis.
- Liver Cirrhosis /
- Hypertension， Portal /
- Hemorrhage /
- Treatment Outcome /
- Meta-Analysis

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图 1 文献筛选流程图

Figure 1. Literature screening flowchart

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图 2 2组术后门静脉压力的Meta分析

Figure 2. Comparison of postoperative portal vein pressure

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图 3 2组术后门静脉内径的Meta分析

Figure 3. Comparison of postoperative diameter of the portal vein

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图 4 2组术后再出血发生率的Meta分析

Figure 4. Comparison of postoperative rebleeding rate

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图 5 2组术后病死率的Meta分析

Figure 5. Comparison of postoperative mortality rate

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图 6 2组术后腹水发生率的Meta分析

Figure 6. Comparison of the incidence of postoperative ascites

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图 7 2组术后门静脉高压胃肠病发生率的Meta分析

Figure 7. Comparison of the incidence of postoperative portal gastrointestinal disease

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图 8 2组术后肝性脑病发生率的Meta分析

Figure 8. Comparison of the incidence of postoperative hepatic encephalopathy

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图 9 2组术后血小板水平的Meta分析

Figure 9. Comparison of postoperative platelet levels

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图 10 2组术后白蛋白水平的Meta分析

Figure 10. Comparison of postoperative albumin levels

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图 11 术后再出血率漏斗图

Figure 11. Funnel plot of postoperative rebleeding rate

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图 12 术后再出血率Egger’s检测图

Figure 12. Egger’s test chart for postoperative rebleeding rate

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表 1 8篇纳入文献的基本特征及质量评价

Table 1. Basic characteristics and quality evaluation of 8 included literature

第一作者	发表年份	研究类型	组别	样本量（例）	男/女（例）	年龄（岁）	肝功能Child-Pugh分级（A/B/C，例）	随访时间（月）	文献质量
权华^［9］	2010	随机对照	PTVE+PSE组 PTVE组	37 56	62/31	18～67	47/36/10	48～69	中等
Duan^［16］	2014	回顾性	PTVE+PSE组 PTVE组	31 34	21/10 23/11	40.1±10.9 39.7±9.9	4/21/6 6/23/5	6～24	高
谢正元^［15］	2015	回顾性	PTVE+PSE组 PTVE组	32 12	25/7 10/2	52.1±10.2 50.5±10.0	4/25/3 2/9/1	6	中等
刘晓亮^［12］	2016	回顾性	PTVE+PSE组 PTVE组	65 59	79/45	41.8±5.7	21/78/25	6～18	中等
潘峰^［13］	2018	回顾性	PTVE+PSE组 PTVE组	34 22	23/11 14/8	58.0±14.0 51.0±19.0	31/17/8	3～24	高
武和平^［14］	2018	回顾性	PTVE+PSE组 PTVE组	36 13	21/15 8/5	52.35±5.24 50.65±5.21	6/25/5 3/10/0	6	中等
张明礼^［10］	2019	随机对照	PTVE+PSE组 PTVE组	36 36	28/8 27/9	47.75±4.01 47.72±3.93	0/25/11 0/22/14		中等
孙巧玉^［11］	2019	随机对照	PTVE+PSE组 PTVE组	45 44	29/16 30/14	66.32±10.71 64.25±9.84	12/24/9 12/25/7	3～12	中等

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