摘要:
目的 评价明胶海绵与聚乙烯醇(PVA)颗粒作为部分脾栓塞材料治疗肝硬化脾亢的安全性和疗效.方法 计算机检索PubMed、Embase、The Cochrane library、中国生物医学文献数据库、中国知网、万方数据及维普医药数据库,纳入所有使用PVA颗粒与明胶海绵行部分脾栓塞术治疗肝硬化脾亢的对照试验,检索时限截至2016年5月.将符合标准的文献纳入后进行质量评价与数据提取,使用RevMan 5.3软件进行Meta分析.结果 共纳入5篇研究、197例患者,其中PVA组92例,明胶海绵组105例.Meta分析显示:PVA组术后1个月WBC(WMD=0.4,95% CI:0.05~0.75,P<0.05)、术后6个月的WBC水平(WMD =0.39,95% CI:0.06 ~0.71,P<0.05)以及术后6个月PLT水平(WMD=8.08,95% CI:1.65~14.51,P<0.05)均高于明胶海绵组.PVA组术后Ⅱ度以上疼痛的发生率较高(RR=1.32,95% CI:1.14 ~ 1.54,P<0.05)、术后疼痛持续时间较长(RR =2.01,95% CI:1.36~2.66,P<0.05).二者在术后1个月PLT水平、术后发热和并发症方面差异无统计学意义(均P>0.05).结论 对于肝硬化脾亢患者,选用PVA颗粒行部分脾栓塞术,在改善血液学指标方面的近、远期疗效优于明胶海绵,但也增加了患者术后疼痛的程度和持续时间.%Objective To evaluate the effectiveness and safety of partial splenic embolization using polyvinyl alcohol versus gelfoam to treat hypersplenism in cirrhotic patients.Methods A literature search was performed in databases which included PubMed,Embase,Cochrane library,Sinomed,CNKI,Wangfang data and VIP for trials on partial splenic embolism using PVA or gelfoam to treat hypersplenism in cirrhotic patients.The study was censored in May 2016.After data extraction and assessment of quality,a meta-analysis was performed using the RevMan 5.3 software.Results Five studies which involved 197 patients were selected in this study.Included into the PVA group were 92 patients and the gelfoam group 105 patients.On Meta-analysis,the PVA group had a higher value of WBC a month after PSE (WMD =0.4,95% CI:0.05 ~ 0.75,P < 0.05),higher values of WBC (WMD =0.39,95% CI:0.06 ~ 0.71,P <0.05) and PLT (WMD =8.08,95% CI:1.65 ~ 14.51,P < 0.05) on month 6 post-embolization.The degree of post-embolization pain was more severe (RR =1.32,95% CI:1.14 ~ 1.54,P < 0.05) and the length of painful time was longer (RR =2.01,95% CI:1.36 ~ 2.66,P <0.05) in the PVA group.There were no significant differences in the values of PLT,fever and complications (all P > 0.05).Conclusions PSE using PVA achieved better short-term and long-term results in hematological indicators than gelfoam.However,the degree and extent of duration of pain were significantly longer.