Paper - WANFANG MED ONLINE

You Position: Home > Paper

Transjugular intrahepatic portosystemic shut vs total paracentesis for treatment of refractory ascites in patients with cirrhosis: A metaanalysis

( views:0, downloads:0 )

Author:: No author available

Journal Title:: World Chinese Journal of Digestology

Issue:: 2

DOI:: 10.11569/wcjd.v25.i2.129

Key Word:: 肝硬化;顽固性腹水;经颈静脉肝内门体分流术;Meta分析;Liver cirrhosis;Refractory ascites;Transjugular intrahepatic portosystemic;Metaanalysis

Abstract：目的评价经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic,TIPS)和腹腔穿刺放液(total paracentesis,TP)治疗肝硬化顽固性腹水患者的疗效与安全性.方法检索PubMed、Web of Science、Medline、EMBASE、中国知网、万方医学全文数据库及中国生物医学文献数据库,纳入TIPS对比TP治疗肝硬化顽固性腹水的随机对照研究,并由2位评价者独立进行资料提取和文献质量评价,采用Reman5.2软件对资料进行Meta分析.结果共纳入符合标准的文献6篇,总共390例患者(TIPS组192例,TP组198例).Meta分析结果显示:与TP组相比,TIPS能显著改善术后患者无需肝移植而存活(liver transplantation-free,LTF)的生存率(HR=0.61,P=0.0009),减少腹水复发[相对危险度(relative risk,RR)=0.61,P＜ 0.0001];降低肾素[加权均数差(weighted mean difference,WMD)=-5.41,P＜0.00001]和醛固酮水平(WMD=-23.72,P=0.02),控制水钠潴留;同时减少肝肾综合征发病率(RR=0.38,P=0.03),但TIPS更易导致肝性脑病(hepatic encephalopathy,HE)发生(RR=1.81,P=0.007).此外两者术后总病死率、住院天数、术后消化道出血、自发性细菌性腹膜炎发生率及在改善肝肾功能方面无明显差异.结论与传统治疗性腹腔穿刺相比,TIPS更易导致术后HE发生,但在改善LTF生存率、减少腹水复发、控制水钠潴留、预防肝肾综合征方面有着显著的优势.

Reference

[1]黄娟君,祝伟,刘杰,等.TIPS与EVL比较治疗肝硬化性食管静脉曲张出血的Meta分析[J].2015,(12).
[2]周支瑞,张天嵩,李博,等.生存曲线中Meta分析适宜数据的提取与转换[J].2014,(3).
[3]李莹,练晶晶,罗添成,等.预防肝硬化食管静脉曲张再出血的成本效果研究[J].2016,(2).
[4]Francesco Salerno,Manuela Merli,Oliviero Riggio,etc.Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites[J].2004,40(3).
[5]Arun J. Sanyal,Chris Genning,K.Rajender Reddy,etc.The North American Study for the Treatment of Refractory Ascites[J].2003,124(3).
[7]Henriksen JH,Bendtsen F,Moller S.Determinants of the renin-angiotensin-aldosterone system in cirrhosis with special emphasis on the central blood volume.[J].2006,41(4).
[8]Gonzalez M,Albillos A,Molinero LM,etc.A meta-analysis of transjugular intrahepatic portosystemic shunt versus paracentesis for refractory ascites.[J].2005,43(6).
[9]Emmanuel E Zervos,Alexander S Rosemurgy.Management of medically refractory ascites[J].2001,181(3).
[10]邵茉莉,刘冰熔.肝硬化腹水形成机制的研究现状[J].2013,(2).
[11]Gennaro D’Amico,Angelo Luca,Alberto Morabito,etc.Uncovered Transjugular Intrahepatic Portosystemic Shunt for Refractory Ascites: A Meta-Analysis[J].2005,129(4).
[12]P S, Kamath,R H, Wiesner,M, Malinchoc,etc.A model to predict survival in patients with end-stage liver disease.[J].2001,33(2).
[13]H Ferral,H Bjarnason,S A Wegryn,etc.Refractory ascites: early experience in treatment with transjugular intrahepatic portosystemic shunt.[J].1993,189(3).
[14]Runyon,B.A..Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012[J].2013,57(4).
[15]Pere Ginès,Juan Uriz,Blas Calahorra,etc.Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis[J].2002,123(6).
[16]Erwin Biecker.Diagnosis and therapy of ascites in liver cirrhosis[J].2011,(10).