聚四氟乙烯覆膜支架移植物与裸支架在经颈静脉肝内门体分流术中的应用：系统评价与Meta分析
Polytetrafluoroethylene-Covered Stent Graft Versus Bare Stent in Transjugular Intrahepatic Portosystemic Shunt: Systematic Review and Meta-Analysis.
作者信息
Triantafyllou Tania, Aggarwal Piyush, Gupta Ekansh, Svetanoff Wendy Jo, Bhirud Deepak Prakash, Singhal Saurabh
机构信息
1 Hippokration General Hospital, University of Athens , Athens, Greece .
2 All India Institute of Medical Sciences , New Delhi, India .
出版信息
J Laparoendosc Adv Surg Tech A. 2018 Jul;28(7):867-879. doi: 10.1089/lap.2017.0560. Epub 2018 Jan 22.
BACKGROUND & AIMS: Transjugular Intrahepatic Portosystemic Shunt (TIPS) is used to control refractory variceal bleeding secondary to portal hypertension. This meta-analysis was conducted to systematically review polytetrafluoroethylene-covered stent grafts (CS) versus bare stents (BS) in TIPS procedure.
METHODS
Systematic search of literature databases was done from January-1990 till April-2017, using predecided keywords. Outcome measures studied were (1) primary-patency (PP) at 1 year (defined as absence of shunt insufficiency at 1 year), (2) rebleeding (RE) (3) new-onset hepatic encephalopathy ([HE] new-onset or worsening encephalopathy following the procedure), and (4) survival at 1 year (SU). Odds ratio (OR) was calculated for each outcome variable. Between-study heterogeneity was assessed by the I statistics and χ Q-test.
RESULTS
Fourteen studies (4 RCTs, 2 prospective nonrandomized, and 8 retrospective) were included with 2519 patients (1548 patients in BS group and 971 patients in CS group). Three-quarter outcome measures showed significantly better results with CS. PP was pooled from 13 studies and showed an OR = 4.75 (95% confidence interval [CI] = 3.32-6.79; P < .00001; I = 44%) in favor of CS. RE was pooled from six studies with odds ratio (OR) = 0.37(95% CI = 0.24-0.56; P < .00001; I = 0%) in favor of CS. SU was pooled from 11 studies with OR = 1.85 (95% CI = 1.44-2.38; P < .00001; I = 0%) in favor of CS. On subset analysis for RCTs, three outcome variables favored CS with minimal heterogeneity [PP: OR = 4.18 (95% CI = 2.66-6.55; P < .00001; I = 0%). RE: OR = 0.43 (95% CI = 0.25-0.72; P < .001; I = 0%). SU: OR = 1.85 (95% CI = 1.44-2.38, P < .00001; I = 0%)]. HE showed no difference between two stents on the overall and subset pooled analysis. Overall: OR = 0.86 (95% CI = 0.68-1.08; P = .19; I = 4%). Only RCTs: OR = 0.91 (95% CI = 0.63-1.32, P = .63; I = 0%).
CONCLUSIONS
CS is associated with better primary patency and survival and lesser rate of rebleeding than BS in patients undergoing TIPS procedure. There is no difference in new-onset hepatic encephalopathy.
背景与目的
经颈静脉肝内门体分流术（TIPS）用于控制门静脉高压继发的难治性静脉曲张出血。本荟萃分析旨在系统评价聚四氟乙烯覆膜支架移植物（CS）与裸支架（BS）在TIPS手术中的应用效果。
方法
使用预先确定的关键词，对1990年1月至2017年4月的文献数据库进行系统检索。研究的结局指标包括：（1）1年时的原发性通畅率（PP）（定义为1年时无分流功能不全）；（2）再出血（RE）；（3）新发肝性脑病（[HE]，术后新发或恶化的脑病）；（4）1年生存率（SU）。计算每个结局变量的比值比（OR）。通过I统计量和χ² Q检验评估研究间的异质性。
结果
纳入14项研究（4项随机对照试验、2项前瞻性非随机研究和8项回顾性研究），共2519例患者（BS组1548例，CS组971例）。四分之三的结局指标显示CS的效果明显更好。13项研究汇总的PP显示，支持CS的OR = 4.75（95%置信区间[CI] = 3.32 - 6.79；P <.00001；I² = 44%）。6项研究汇总的RE的比值比（OR）= 0.37（95% CI = 0.24 - 0.56；P <.00001；I² = 0%），支持CS。11项研究汇总的SU的OR = 1.85（95% CI = 1.44 - 2.38；P <.00001；I² = 0%），支持CS。在随机对照试验的亚组分析中，三个结局变量支持CS，异质性最小[PP：OR = 4.18（95% CI = 2.66 - 6.55；P <.00001；I² = 0%）。RE：OR = 0.43（95% CI = 0.25 - 0.72；P <.001；I² = 0%）。SU：OR = 1.85（95% CI = 1.44 - 2.38，P <.00001；I² = 0%）]。在总体和亚组合并分析中，两种支架在HE方面无差异。总体：OR = 0.86（95% CI = 0.68 - 1.08；P = 0.19；I² = 4%）。仅随机对照试验：OR = 0.91（95% CI = 0.63 - 1.32，P = 0.63；I² = 0%）。
结论
在接受TIPS手术的患者中，与BS相比，CS具有更好的原发性通畅率和生存率，再出血率更低。新发肝性脑病无差异。
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