Guo Ding-Fan, Fan Lin-Wei, Le Qi, Huang Cai-Bin
Department of Gastroenterology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.
The First Clinical Medical School of Nanchang University, Nanchang, China.
Front Pharmacol. 2022 Aug 16;13:968988. doi: 10.3389/fphar.2022.968988. eCollection 2022.
Transjugular intrahepatic portosystemic shunt (TIPS) has been performed on patients with cirrhosis and portal vein thrombosis (PVT) to prevent rebleeding; however, the associated evidence is scarce. Hence, the study aimed to evaluate the feasibility and efficacy of TIPS in patients with cirrhosis and PVT and promote personalized treatment in such patients. Literature was systematically obtained from PubMed, EMBASE, Cochrane Library, and Web of Science. Data from the included studies were extracted, and meta-analyses by the random effects model were used to pool data across studies. Heterogeneity was assessed using Cochran's Q and I statistics. The source of heterogeneity was explored using subgroup analyses and meta-regressions. A total of 11 studies comprising 703 patients with cirrhosis and portal vein thrombosis (PVT: complete, 32.2%; chronic, 90.2%; superior mesenteric vein or splenic vein involvement, 55.2%; cavernous transformation, 26.8%) were included. TIPS showed feasibility in 95% of the cases (95% confidence interval [CI]: 89%-99%) with heterogeneity (I = 84%, < 0.01) due to cavernous transformation. The pooled rebleeding rate was 13% (95% CI: 7%-20%) with heterogeneity (I = 75%, < 0.01) explained by chronic PVT and anticoagulation (AC) therapy. Hepatic encephalopathy occurred in 32% of patients. The survival rate, portal vein recanalization rate, and shunt patency rate were 80%, 82%, and 77%, respectively. TIPS is feasible and effectively prevents rebleeding in patients with cirrhosis and PVT, regardless of cavernous transformation of the portal vein. Due to a potentially high risk of rebleeding and no apparent benefits of AC, post-TIPS AC must be employed cautiously. : [https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=258765], identifier [CRD42021258765].
已对肝硬化和门静脉血栓形成（PVT）患者进行经颈静脉肝内门体分流术（TIPS）以预防再出血；然而，相关证据稀缺。因此，本研究旨在评估TIPS在肝硬化和PVT患者中的可行性和疗效，并促进对此类患者的个性化治疗。从PubMed、EMBASE、Cochrane图书馆和科学网系统获取文献。提取纳入研究的数据，并使用随机效应模型进行荟萃分析以汇总各研究的数据。使用Cochran's Q和I统计量评估异质性。使用亚组分析和荟萃回归探索异质性来源。共纳入11项研究，包括703例肝硬化和门静脉血栓形成患者（PVT：完全性，32.2%；慢性，90.2%；肠系膜上静脉或脾静脉受累，55.2%；海绵样变性，26.8%）。TIPS在95%的病例中显示出可行性（95%置信区间[CI]：89%-99%），因海绵样变性存在异质性（I = 84%，P < 0.01）。汇总的再出血率为13%（95% CI：7%-20%），因慢性PVT和抗凝（AC）治疗存在异质性（I = 75%，P < 0.01）。32%的患者发生肝性脑病。生存率、门静脉再通率和分流通畅率分别为80%、82%和77%。TIPS是可行的，并且能有效预防肝硬化和PVT患者的再出血，无论门静脉是否存在海绵样变性。由于再出血风险可能较高且AC无明显益处，TIPS术后必须谨慎使用AC。: [https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=258765]，标识符[CRD42021258765]
