Chirurgia (Bucur). 2020 Nov-Dec;115(6):707-714. doi: 10.21614/chirurgia.115.6.707.
Background-Objectives: It has been reported, that high posthepatectomy portal vein pressure (PVP) has deleterious effect on the liver parenchyma and causes posthepatectomy liver failure (PHLF) and increased 90-day mortality. Terlipressin, is widely used to mitigate the effects of portal hyper-tension. Randomised clinical trials (RCTs) demonstrated encouraging results of use of terlipressin for modulation of increased posthepatectomy PVP. The aim of the present study was to evaluate the effectiveness of the pharmacological modulation of the increased posthepatectomy PVP after major hepatectomy. Systematic literature searches of electronic databases in accordance with PRISMA was conducted. Meta-analysis was conducted using both fixed- and random-effects models. Three randomised controlled trials (RCTs) comparing terlipressin versus placebo including 284 patients of pooled 60 studies were selected. Placebo cohort patients were significantly younger by 5 years compared to terlipressin cohort. However, the terlipressin cohort demonstrated significantly shorter intensive care unit (ICU) stay compared to placebo cohort. The first meta-analysis demonstrated that terlipressin cohort patients although significantly older by 5 years had significantly shorter ICU stay compared to placebo cohort. Furthermore, though statistically nonsignificant only 6% of terlipressin patients needed inotropic support compared to 16.4% of placebo cohort.
背景-目的：据报道，高肝切除术后门静脉压力（PVP）对肝实质有不良影响，并导致肝切除术后肝功能衰竭（PHLF）和 90 天死亡率增加。特利加压素广泛用于减轻门静脉高压的影响。随机临床试验（RCT）表明特利加压素用于调节肝切除术后升高的 PVP 的使用结果令人鼓舞。本研究旨在评估在大肝切除术后对升高的 PVP 进行药物调节的有效性。按照 PRISMA 进行了电子数据库的系统文献检索。使用固定效应和随机效应模型进行了荟萃分析。选择了 3 项比较特利加压素与安慰剂的随机对照试验（RCT），共纳入 284 名患者，来自 60 项研究的汇总数据。与特利加压素组相比，安慰剂组患者的年龄明显小 5 岁。然而，与安慰剂组相比，特利加压素组患者的 ICU 住院时间明显缩短。第一项荟萃分析表明，尽管特利加压素组患者年龄大 5 岁，但与安慰剂组相比，他们的 ICU 住院时间明显缩短。此外，尽管统计学上无显著意义，但只有 6%的特利加压素患者需要使用正性肌力支持，而安慰剂组为 16.4%。
