Department of Vascular and Interventional Radiology, Ghent University Hospital, Ghent, Belgium.
Department of Vascular and Interventional Radiology, Ghent University Hospital, Ghent, Belgium.
J Vasc Interv Radiol. 2023 Aug;34(8):1382-1398.e10. doi: 10.1016/j.jvir.2023.05.014. Epub 2023 May 16.
To investigate the technical outcome, clinical outcome, and patency of transjugular intrahepatic portosystemic shunt (TIPS) in pediatric portal hypertension (PHT).
A systematic search of MEDLINE/PubMed, EMBASE, Cochrane databases, ClinicalTrials.gov, and WHO ICTRP registries was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An a priori protocol was registered at the PROSPERO database. Original full-text articles on pediatric patients (sample size of ≥5 patients with upper age limit of 21 years) with PHT who underwent TIPS creation for any indication were included.
Seventeen studies with 284 patients (average-weighted age of 10.1 years) were included, with an average-weighted follow-up of 3.6 years. TIPS was technically successful in 93.3% (95% confidence interval [CI], 88.5%-97.1%) of patients, with a major adverse event rate of 3.2% (95% CI, 0.7-6.9) and adjusted hepatic encephalopathy rate of 2.9% (95% CI, 0.6-6.3). The pooled 2-year primary and secondary patency rates were 61.8% (95% CI, 50.0-72.4) and 99.8% (95% CI, 96.2%-100.0%), respectively. Stent type (P = .002) and age (P = .04) were identified as a significant source of heterogeneity for clinical success. In subgroup analysis, the clinical success rate was 85.9% (95% CI, 77.8-91.4) in studies with a majority of covered stents, and 87.6% (95% CI, 74.1-94.6) in studies with a median age of 12 years or older.
This systematic review and meta-analysis demonstrates that a TIPS is a feasible and safe treatment for pediatric PHT. To improve clinical outcome and patency on the long term, the use of covered stents should be encouraged.
探讨经颈静脉肝内门体分流术（TIPS）治疗小儿门脉高压（PHT）的技术效果、临床效果和通畅率。
根据系统评价和荟萃分析的首选报告项目，对 MEDLINE/PubMed、EMBASE、Cochrane 数据库、ClinicalTrials.gov 和世界卫生组织 ICTRP 登记处进行了系统检索。预先制定的方案在 PROSPERO 数据库中进行了注册。纳入了对接受 TIPS 治疗的小儿患者（样本量≥5 例，上限年龄为 21 岁）的原始全文文章，无论其适应证如何。
纳入了 17 项研究，共 284 例患者（平均加权年龄为 10.1 岁），平均加权随访时间为 3.6 年。TIPS 在 93.3%（95%置信区间 [CI]，88.5%-97.1%）的患者中技术上是成功的，主要不良事件发生率为 3.2%（95% CI，0.7-6.9），调整后的肝性脑病发生率为 2.9%（95% CI，0.6-6.3）。2 年的原发性和继发性通畅率的合并率分别为 61.8%（95% CI，50.0-72.4）和 99.8%（95% CI，96.2%-100.0%）。支架类型（P=.002）和年龄（P=.04）被确定为临床成功的显著异质性来源。在亚组分析中，在大多数使用覆盖支架的研究中，临床成功率为 85.9%（95% CI，77.8-91.4），在中位年龄为 12 岁或以上的研究中为 87.6%（95% CI，74.1-94.6）。
本系统评价和荟萃分析表明，TIPS 是治疗小儿 PHT 的一种可行且安全的治疗方法。为了提高长期的临床效果和通畅率，应鼓励使用覆盖支架。
