Triantafyllou Tania, Aggarwal Piyush, Gupta Ekansh, Svetanoff Wendy Jo, Bhirud Deepak Prakash, Singhal Saurabh
1 Hippokration General Hospital, University of Athens , Athens, Greece .
2 All India Institute of Medical Sciences , New Delhi, India .
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.
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.
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%).
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.
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。
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。
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%）。
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。
