不同术式治疗门静脉高压症上消化道出血的效果荟萃分析

摘要

目的 比较防治肝硬化门静脉高压症患者上消化道出血主要术式的效果.方法 检索门静脉高压症相关文献,应用Revman 5.3软件行Meta分析,评价各术式的疗效.结果 根据纳入标准,最终选出文献24篇.Meta分析显示断流联合分流以及单纯断流和分流三种术式的手术死亡率差异无统计学意义(P＞0.05).联合组术后再出血率低于断流组(P＜0.05),术后肝性脑病发生率低于分流术组(P＜0.05).联合组术后1年、3年生存率优于断流术组(均P＜0.05),术后5年生存率两者差异无统计学意义(P＞0.05).联合组与分流术组两者术后1年、3年生存率差异无统计学意义(均P＞0.05).结论 断流联合分流术疗效优于单纯断流术或分流术,术后生存率明显高于单纯断流术,适用于有高危出血倾向且肝功能较好的患者.%Objective To compare the effectiveness of surgical procedures (devascularization,shunt and combined shunt and devascularization) in treating recurrent variceal bleeding and other complications in patients with portal hypertension.Methods A systematic literature search was carried out on patients with portal hypertension,and a Meta-analysis was conducted using Revman 5.3 software to evaluate the effectiveness of different surgical procedures on recurrent esophageal variceal bleeding,hepatic encephalopathy,operative mortality and survival rates.Results A total of 24 trials were finally selected using predetermined inclusion criteria.Meta-analysis showed there was no significant difference among the three operations on operative mortality (P ＞ 0.05).The rebleeding rate of the combined group was significantly lower than the devascularization group (P ＜ 0.05).The encephalopathy rate of the combined group was significantly lower than the shunt group (P ＜ 0.05),and the 1-year and 3-year survival rates of the combined group were better than the devascularization group (both P ＜ 0.05),but there were no significant difference in the 5-year survival rates between these two groups (P ＞ 0.18).The 1-year and 3-year survival rates were not significantly different between the combined and the shunt groups (both P ＞ 0.05).Conclusions Combined shunt and devascularization had better therapeutic effectiveness than either devascularization alone or shunt alone in patients with portal hypertension with a high rebleeding risk.There were no significant difference among the three surgical procedures in operative mortality.The survival rates of combined surgery were significantly better than devascrlarization alone.