Ren Hongcheng, Ding Mingchao, Huang Xiaoyong, Wang Bin, Chi Guoqing, Shao Changgang, Song Shiyong, Song Wenjie, Shi Ruina
Department of Intervention Vascular, Aerospace Center Hospital, Beijing, China.
J Minim Access Surg. 2022 Oct-Dec;18(4):560-566. doi: 10.4103/jmas.jmas_262_21.
The meta-analysis was conducted to systematically assess the efficacy and safety of generic stent-graft/bare-stent combination compared with Fluency stent alone in transjugular intrahepatic portosystemic shunt procedure for refractory variceal bleeding.
PubMed, EMBASE, Scopus, Web of Science and the Cochrane Database were searched for relevant studies from January 1990 to September 2020; outcome measures studied were primary patency, hepatic encephalopathy, survival, re-bleeding and portal venous pressure.
Four studies (1 randomised controlled trial and 3 retrospective studies) with 449 subjects (157 patients in the combined stent group and 292 patients in the covered stent group) were included. No significant difference was observed in the incidence of mortality (hazard ratio [HR] = 1.069, 95% confidence interval [CI] [0.524, 2.178]), hepatic encephalopathy (odds ratio [OR] = 0.860, 95% CI [0.341, 2.169], P = 0.750) and re-bleeding (OR = 1.049, 95% CI [0.226, 4.881], P = 0.951). Compared with Fluency stent alone, combination therapy was associated with moderate decrease in outcomes on the post-operative portal venous pressure (standard mean difference [SMD] -0.210, 95% CI [-0.418, -0.001], P = 0.049) and was not associated with significant decrease in outcomes on the pre-operative portal venous pressure (SMD - 0.129, 95% CI [-0.336, 0.078], P = 0.223). The primary patency was significantly lower in the Fluency/bare-stent combination group (HR = 0.473, 95% CI [0.288, 0.776]).
Generic stent-graft/bare-stent combination therapy was associated with significantly lower primary patency compared to Fluency stent alone.
进行荟萃分析，以系统评估在经颈静脉肝内门体分流术治疗难治性静脉曲张出血中，通用覆膜支架/裸支架组合与单纯Fluency支架相比的疗效和安全性。
检索PubMed、EMBASE、Scopus、Web of Science和Cochrane数据库，查找1990年1月至2020年9月的相关研究；研究的结局指标包括原发性通畅率、肝性脑病、生存率、再出血和门静脉压力。
纳入四项研究（1项随机对照试验和3项回顾性研究），共449名受试者（联合支架组157例患者，覆膜支架组292例患者）。在死亡率（风险比[HR]=1.069，95%置信区间[CI][0.524，2.178]）、肝性脑病（比值比[OR]=0.860，95%CI[0.341，2.169]，P=0.750）和再出血（OR=1.049，95%CI[0.226，4.881]，P=0.951）的发生率上未观察到显著差异。与单纯Fluency支架相比，联合治疗术后门静脉压力的结局有中度下降（标准化均数差[SMD]-0.210，95%CI[-0.418，-0.001]，P=0.049），而术前门静脉压力的结局无显著下降（SMD-0.129，95%CI[-0.336，0.078]，P=0.223）。Fluency/裸支架组合组的原发性通畅率显著更低（HR=0.473，95%CI[0.288，0.776]）。
与单纯Fluency支架相比，通用覆膜支架/裸支架联合治疗的原发性通畅率显著更低。
