肝硬化难治性腹水的治疗选择——系统评价和荟萃分析。
Current treatment options of refractory ascites in liver cirrhosis - A systematic review and meta-analysis.
机构信息
Department for Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, BHH D115, Freiburgstrasse 10, CH-3008 Bern, Switzerland; Department of Biomedical Research, University of Bern, Bern, Switzerland.
Department for Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, BHH D115, Freiburgstrasse 10, CH-3008 Bern, Switzerland; Department of Biomedical Research, University of Bern, Bern, Switzerland.
出版信息
Dig Liver Dis. 2022 Aug;54(8):1007-1014. doi: 10.1016/j.dld.2021.12.007. Epub 2022 Jan 10.
BACKGROUND
Refractory ascites is a severe complication of liver cirrhosis and treatment options consist in large volume paracentesis, transjugular intrahepatic portosystemic shunt, alfapump®, peritoneovenous shunt and permanent indwelling peritoneal catheter.
AIM
Our aim was to assess the efficacy, mortality and complications of each treatment.
METHODS
We performed a systematic review using Pubmed and Embase. Frequencies were summarized with Comprehensive Meta-Analysis Software.
RESULTS
Seventy-seven studies were included. In patients with transjugular intrahepatic portosystemic shunt, 1-year mortality was 33% (95% CI 0.29-0.39, I=82.1; τ = 0.37; p<0.001) with lower mortality in newer studies (26% vs. 44%). At 6 months, mortality in patients with alfapump® was 24% (95% CI 0.16-0.33, I=0.00; τ = 0.00; p = 0.83), 31% developed acute kidney injury (95% CI 0.18-0.48, I=44.0; τ = 0.22; p = 0.15). Mortality at 12 months was 44% (95% CI 32%-58%, I=76.7, τ = 0.44, p<0.001) in peritoneovenous shunts and 45% (95% CI 38%-53%, I=61.4, τ = 0.18, p = 0.003) in large volume paracentesis, respectively. Overall mortality in patients with permanent indwelling catheters was 66% (95% CI 33%-89%, I=82.5, τ = 1.57, p = 0.001).
DISCUSSION
Mortality in patients with transjugular intrahepatic portosystemic shunt was lower in newer studies, probably due to a better patient selection. Acute kidney injury was frequent in patients with alfapump®. Permanent indwelling catheters seemed to be a good option in a palliative setting.
背景
难治性腹水是肝硬化的严重并发症，治疗选择包括大量腹腔穿刺、经颈静脉肝内门体分流术、Alfapump®、腹膜静脉分流术和永久性留置腹膜导管。
目的
我们旨在评估每种治疗方法的疗效、死亡率和并发症。
方法
我们使用 Pubmed 和 Embase 进行了系统评价。使用 Comprehensive Meta-Analysis Software 总结频率。
结果
共纳入 77 项研究。经颈静脉肝内门体分流术患者 1 年死亡率为 33%（95%CI0.29-0.39，I=82.1；τ=0.37；p<0.001），新研究死亡率较低（26%比 44%）。6 个月时，Alfapump®患者死亡率为 24%（95%CI0.16-0.33，I=0.00；τ=0.00；p=0.83），31%发生急性肾损伤（95%CI0.18-0.48，I=44.0；τ=0.22；p=0.15）。腹膜静脉分流术患者 12 个月死亡率为 44%（95%CI32%-58%，I=76.7，τ=0.44，p<0.001），大量腹腔穿刺术患者死亡率为 45%（95%CI38%-53%，I=61.4，τ=0.18，p=0.003）。永久性留置导管患者总体死亡率为 66%（95%CI33%-89%，I=82.5，τ=1.57，p=0.001）。
讨论
经颈静脉肝内门体分流术患者的新研究死亡率较低，可能是由于患者选择更好。Alfapump®患者常发生急性肾损伤。永久性留置导管在姑息治疗中似乎是一个不错的选择。
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