Qi Xingshun, Tian Yulong, Zhang Wei, Yang Zhiping, Guo Xiaozhong
Department of Gastroenterology and Meta-Analysis Study Interest Group, General Hospital of Shenyang Military Area, Shenyang, China.
Department of Interventional Radiology and Key Laboratory of Diagnostic Imaging and Interventional Radiology of Liaoning Province, First Affiliated Hospital of China Medical University, Shenyang, China.
Therap Adv Gastroenterol. 2017 Jan;10(1):32-41. doi: 10.1177/1756283X16671286. Epub 2016 Oct 20.
Transjugular intrahepatic portosystemic shunt (TIPS) is a standard treatment option for the management of portal hypertension in liver cirrhosis. Since the introduction of covered stents, shunt patency has been greatly improved. However, it remains uncertain about whether covered stents could improve survival. A meta-analysis of randomized controlled trials has been performed to compare the outcomes of covered bare stents for TIPS.
PubMed, EMBASE, and Cochrane Library databases were searched to identify the relevant randomized controlled trials. Overall survival, shunt patency, and hepatic encephalopathy were the major endpoints. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was calculated. Cochrane risk of bias tool was employed.
Overall, 119 papers were identified. Among them, four randomized controlled trials were eligible. Viatorr covered stents alone, Fluency covered stents alone, and Viatorr plus Fluency covered stents were employed in one, two, and one randomized controlled trials, respectively. Risk of bias was relatively low. Meta-analyses demonstrated that the covered-stents group had significantly higher probabilities of overall survival (HR = 0.67, 95% CI = 0.50-0.90, = 0.008) and shunt patency (HR = 0.42, 95% CI = 0.29-0.62, < 0.0001) than the bare-stents group. Additionally, the covered-stents group might have a lower risk of hepatic encephalopathy than the bare-stents group (HR = 0.70, 95% CI = 0.49-1.00, = 0.05). The heterogeneity among studies was not statistically significant in the meta-analyses.
Compared with bare stents, covered stents for TIPS may improve the overall survival. In the era of covered stents, the indications for TIPS may be further expanded.
经颈静脉肝内门体分流术（TIPS）是肝硬化门静脉高压症治疗的标准选择。自覆膜支架应用以来，分流道通畅率有了显著提高。然而，覆膜支架能否提高生存率仍不确定。已进行了一项随机对照试验的荟萃分析，以比较TIPS使用覆膜支架和裸支架的疗效。
检索PubMed、EMBASE和Cochrane图书馆数据库，以识别相关的随机对照试验。总生存率、分流道通畅率和肝性脑病是主要终点。计算了风险比（HR）及95%置信区间（CI）。计算了异质性。采用Cochrane偏倚风险工具。
共识别出119篇论文。其中，四项随机对照试验符合条件。分别有一项、两项和一项随机对照试验使用了单独的Viatorr覆膜支架、单独的Fluency覆膜支架以及Viatorr加Fluency覆膜支架。偏倚风险相对较低。荟萃分析表明，与裸支架组相比，覆膜支架组的总生存率（HR = 0.67，95%CI = 0.50 - 0.90，P = 0.008）和分流道通畅率（HR = 0.42，95%CI = 0.29 - 0.62，P < 0.0001）显著更高。此外，覆膜支架组的肝性脑病风险可能低于裸支架组（HR = 0.70，95%CI = 0.49 - 1.00，P = 0.05）。荟萃分析中各研究间的异质性无统计学意义。
与裸支架相比，TIPS使用覆膜支架可能提高总生存率。在覆膜支架时代，TIPS的适应证可能会进一步扩大。
