CAJ | 학술논문

目的：比较经颈静脉肝内门体分流术（TIPS）与内镜治疗（ET）对降低肝硬化静脉曲张再出血的疗效和安全性。方法利用计算机在PubMed、Ovid、ScienceDirect、Embase、万方数据库、维普数据库中检索1970年1月1日至2014年1月1日期间关于TIPS 和ET预防肝硬化食管胃静脉曲张再出血疗效方面的随机对照试验，选取符合条件的随机对照试验并对其进行质量评价。使用RevMan 5．2软件对静脉曲张再出血率、治疗后肝性脑病发生率、生存期及住院天数等指标进行Meta分析，并对其中的异质性、敏感性、偏倚作出初步判断。结果共纳入13项随机对照研究，包括TIPS组475例和ET组480例患者。结果显示，与ET相比，TIPS有着更好地控制再出血率及病死率的疗效[相对危险度（RR）＝0．48，95％置信区间（CI）：0．39～0．58，P＜0．001；RR＝0．37，95％CI：0．20～0．69，P＝0．001）]；但TIPS更易导致肝性脑病（RR＝1．84，95％CI：1．47～2．30，P＜0．001）。二者术后总病死率、住院天数差异均无统计学意义[（RR＝1．09，95％CI：0．88～1．35，P＝0．44；加权均数差（WMD）＝－0．44，95％CI：－3．25～2.38，P＝0．76）]。结论 TIPS较之ET更易导致肝性脑病的发生，但在某些特殊情况下，TIPS仍是目前预防肝硬化静脉曲张再出血的第一选择。
목적：비교경경정맥간내문체분류술（TIPS）여내경치료（ET）대강저간경화정맥곡장재출혈적료효화안전성。방법이용계산궤재PubMed、Ovid、ScienceDirect、Embase、만방수거고、유보수거고중검색1970년1월1일지2014년1월1일기간관우TIPS 화ET예방간경화식관위정맥곡장재출혈료효방면적수궤대조시험，선취부합조건적수궤대조시험병대기진행질량평개。사용RevMan 5．2연건대정맥곡장재출혈솔、치료후간성뇌병발생솔、생존기급주원천수등지표진행Meta분석，병대기중적이질성、민감성、편의작출초보판단。결과공납입13항수궤대조연구，포괄TIPS조475례화ET조480례환자。결과현시，여ET상비，TIPS유착경호지공제재출혈솔급병사솔적료효[상대위험도（RR）＝0．48，95％치신구간（CI）：0．39～0．58，P＜0．001；RR＝0．37，95％CI：0．20～0．69，P＝0．001）]；단TIPS경역도치간성뇌병（RR＝1．84，95％CI：1．47～2．30，P＜0．001）。이자술후총병사솔、주원천수차이균무통계학의의[（RR＝1．09，95％CI：0．88～1．35，P＝0．44；가권균수차（WMD）＝－0．44，95％CI：－3．25～2.38，P＝0．76）]。결론 TIPS교지ET경역도치간성뇌병적발생，단재모사특수정황하，TIPS잉시목전예방간경화정맥곡장재출혈적제일선택。
Objective To compare the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS)versus endoscopic therapy (ET)in reducing recurrent variceal hemorrhage in patients with cirrhosis.Methods Data from randomized controlled trials (RCTs)ranging from January 1st,1970 to January 1st,2014 that compared the use of TIPS with ET for the prophylaxis of recurrent variceal bleeding in cirrhosis patients were retrieved from databases including PubMed,Ovid,ScienceDirect,Embase,Wanfang Data,and CNKI.The quality of eligible RCTs was assessed,and a meta-analysis was performed on the incidence of variceal rebleeding (VRB)and post-treatment encephalopathy, deaths due to rebleeding and other causes,and hospitalization days using the Cochrane Collaboration’s RevMan 5.2 software.Heterogeneity test and sensitivity analysis were performed,and publication biases were evaluated.Results Thirteen RCTs involving 475 cases of TIPS and 480 cases of ET were recruited in our study following the inclusion criteria.The meta-analysis showed that compared with the ET group,the TIPS group had a lower incidence of VRB [relative risk (RR)=0.48,95% confidence interval (CI):0.39 -0.58,P<0.001 ],re-duced deaths due to rebleeding (RR =0.37,95%CI:0.20-0.69,P =0.001),but a higher incidence of post-treatment encephalopa-thy (RR =1.84,95%CI:1.47-2.30,P<0.001).No significant differences were found in overall mortality and hospitalization days be-tween the two groups (RR =1.09,95%CI:0.88-1.35,P =0.44;weighted mean difference =-0.44,95%CI:-3.25 -2.38,P=0.76).Conclusions Compared with ET,TIPS increases the risk of hepatic encephalopathy.However,in some special cases,it re-mains the first choice of treatment to prevent variceal rebleeding.