Department of Radiology, Xuzhou Central Hospital, Xuzhou, China.
Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
BMC Gastroenterol. 2023 Oct 2;23(1):340. doi: 10.1186/s12876-023-02969-z.
Budd-Chiari syndrome (BCS) results when the outflow of the hepatic vein (HV) is obstructed. BCS patients exhibiting an accessory HV (AHV) that is dilated but obstructed can achieve significant alleviation of liver congestion after undergoing AHV recanalization. This meta-analysis was developed to explore the clinical efficacy of AHV recanalization in patients with BCS.
PubMed, Embase, and Wanfang databases were searched for relevant studies published as of November 2022, and RevMan 5.3 and Stata 12.0 were used for pooled endpoint analyses.
Twelve total studies were identified for analysis. Pooled primary clinical success, re-stenosis, 1- and 5-year primary patency, 1- and 5-year secondary patency, 1-year overall survival (OS), and 5-year OS rates of patients in these studies following AHV recanalization were 96%, 17%, 91%, 75%, 98%, 91%, 97%, and 96%, respectively. Patients also exhibited a significant reduction in AHV pressure after recanalization relative to preoperative levels (P < 0.00001). Endpoints exhibiting significant heterogeneity among these studies included, AHV pressure (I = 95%), 1-year primary patency (I = 51.2%), and 5-year primary patency (I = 62.4%). Relative to HV recanalization, AHV recanalization was related to a lower rate of re-stenosis (P = 0.002) and longer primary patency (P < 0.00001), but was not associated with any improvements in clinical success (P = 0.88) or OS (P = 0.29) relative to HV recanalization.
The present meta-analysis highlights AHV recanalization as an effective means of achieving positive long-term outcomes in patients affected by BCS, potentially achieving better long-term results than those associated with HV recanalization.
布加综合征（BCS）是由于肝静脉（HV）流出受阻引起的。对于存在扩张但阻塞的副肝静脉（AHV）的 BCS 患者，行 AHV 再通后可显著缓解肝脏淤血。本荟萃分析旨在探讨 AHV 再通治疗 BCS 患者的临床疗效。
检索截至 2022 年 11 月的 PubMed、Embase 和万方数据库中相关研究，并使用 RevMan 5.3 和 Stata 12.0 进行汇总终点分析。
共纳入 12 项研究进行分析。汇总分析显示，AHV 再通后患者的主要临床成功率、再狭窄率、1 年和 5 年原发性通畅率、1 年和 5 年继发性通畅率、1 年总生存率（OS）和 5 年 OS 率分别为 96%、17%、91%、75%、98%、91%、97%和 96%。与术前相比，患者的 AHV 压力在再通后显著降低（P<0.00001）。这些研究中存在显著异质性的终点包括 AHV 压力（I=95%）、1 年原发性通畅率（I=51.2%）和 5 年原发性通畅率（I=62.4%）。与 HV 再通相比，AHV 再通与较低的再狭窄率（P=0.002）和更长的原发性通畅率相关（P<0.00001），但与 HV 再通相比，在临床成功率（P=0.88）或 OS（P=0.29）方面没有改善。
本荟萃分析强调 AHV 再通是治疗 BCS 患者的一种有效方法，可能比 HV 再通获得更好的长期结果。
