Department of Radiology, Ningbo Yinzhou No. 2 Hospital, 315000 Ningbo, Zhejiang, China.
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, 310058 Hangzhou, China.
Diagn Interv Imaging. 2021 May;102(5):279-285. doi: 10.1016/j.diii.2020.11.004. Epub 2020 Dec 7.
The purpose of this study was to make a systematic review and meta-analysis to determine the stent diameter (8mm vs. 10mm) that conveys better safety and clinical efficacy for transjugular intrahepatic portosystemic shunt (TIPS).
Four databases were used to identify clinical trials published from inception until March 2020. Data were extracted to estimate and compare one-year and three-year overall survivals, hepatic encephalopathy, variceal rebleeding, and shunt dysfunction rates between patients with 8mm covered stents and those with 10mm covered stents.
Five eligible studies were selected, which included 489 patients (316 men, 173 women). The 8mm covered stent group had higher efficacy regarding one-year or three-year overall survival (odds ratio [OR], 2.88; P=0.003) and (OR, 1.81; P=0.04) and lower hepatic encephalopathy (OR, 0.69; P=0.04) compared with 10mm covered stent group. There were no significant differences in variceal rebleeding rate (OR 0.80; P=0.67). However, shunt dysfunction was lower in 10mm covered stent group (OR, 2.26; P=0.003).
Our results suggest that the use of 8mm covered stents should be preferred to that of 10mm covered stents for TIPS placement when portal pressure is frequently monitored.
本研究旨在进行系统评价和荟萃分析，以确定经颈静脉肝内门体分流术（TIPS）中哪种支架直径（8mm 与 10mm）更安全、更有效。
我们使用四个数据库检索从建库至 2020 年 3 月发表的临床试验。提取数据以估计和比较 8mm 覆膜支架组和 10mm 覆膜支架组患者的 1 年和 3 年总生存率、肝性脑病、静脉曲张再出血和分流道功能障碍发生率。
共纳入 5 项符合条件的研究，共纳入 489 例患者（316 例男性，173 例女性）。8mm 覆膜支架组 1 年和 3 年总生存率更高（优势比 [OR]，2.88；P=0.003 和 OR，1.81；P=0.04），肝性脑病发生率更低（OR，0.69；P=0.04），与 10mm 覆膜支架组相比。两组静脉曲张再出血率无显著差异（OR，0.80；P=0.67）。然而，10mm 覆膜支架组的分流道功能障碍发生率较低（OR，2.26；P=0.003）。
我们的结果表明，在频繁监测门静脉压力的情况下，TIPS 放置时应优先使用 8mm 覆膜支架，而不是 10mm 覆膜支架。
