李学强,王运兵,龚建平,王春.部分脾动脉栓塞治疗肝硬化继发脾功能亢进的Meta分析[J].中国介入影像与治疗学,2018,15(3):160-166
部分脾动脉栓塞治疗肝硬化继发脾功能亢进的Meta分析
Partial splenic embolization in treatment of hypersplenism secondary to liver cirrhosis: Meta-analysis
投稿时间:2017-04-01  修订日期:2017-07-04
DOI:10.13929/j.1672-8475.201704001
中文关键词:  脾动脉  栓塞,治疗性  脾切除术  脾功能亢进  肝硬化  Meta分析
英文关键词:Splenic artery  Embolization,therapeutic  Splenectomy  Hypersplenism  Liver cirrhosis  Meta-analysis
基金项目:
作者单位E-mail
李学强 重庆市九龙坡区人民医院急诊科, 重庆 401329  
王运兵 重庆医科大学附属第二医院肝胆外科, 重庆 400010  
龚建平 重庆医科大学附属第二医院肝胆外科, 重庆 400010  
王春 重庆市永川区中医院外科, 重庆 402160 fcdc2017@126.com 
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中文摘要:
      目的 通过Meta分析探讨部分脾动脉栓塞(PSE)对肝硬化继发脾功能亢进的疗效。方法 系统检索PubMed、Embase、Cochrane Library、万方数据、中国知网、维普资讯和中国生物医学数据库,获得PSE对比脾切除术治疗肝硬化继发脾功能亢进的随机对照研究、队列研究和病例对照研究。检索截止时间2015年7月25日。使用Cochrane协作网的RevMan软件进行统计分析。主要结局指标包括治疗前后血小板、外周血白细胞和血红蛋白水平,次要结局指标包括手术时间、术中出血量和患者住院时间。结果 共纳入10项原始研究。Meta分析结果提示:PSE治疗后患者血小板[均数差(MD):-87.68,95% CI(-125.70,-49.65)]、外周血白细胞[MD-4.03,95% CI(-5.74,-2.33)]及血红蛋白水平[MD-0.79,95% CI(-1.48,-0.11)]均较治疗前升高。脾切除术后患者血小板[MD-128.31,95% CI(-162.59,-94.03)]、外周血白细胞[MD-5.22,95% CI(-6.65,-3.80)]及血红蛋白水平[(MD-1.42,95% CI(-2.66,-0.18)]均较术前升高。与脾切除术比较,PSE治疗前与治疗后血小板[MD 54.45,95% CI(37.60,71.30)]、外周血白细胞[MD 1.71,95% CI(-0.01,3.42)]及血红蛋白水平[MD 0.78,95% CI(-0.01,1.56)]的差异更小;且术中出血更少[(MD-71.33,95% CI(-78.13,-64.54)],手术时间[MD-34.08,95% CI(-34.78,-33.38)]和患者住院时间[MD-5.59,95% CI(-7.38,-3.79)]也更短。结论 PSE作为一种微创的治疗方式可有效用于肝硬化继发脾功能亢进的治疗。
英文摘要:
      Objective To explore the efficacy of partial splenic embolization (PSE) in the treatment of hypersplenism secondary to liver cirrhosis using Meta-analysis. Methods Randomized control studies, cohort studies and case-control studies concerning the efficacy comparison of PSE and splenectomy in the treatment of hypersplenism secondary to liver cirrhosis were searched on PubMed, Embase, Cochrane Library, Wanfang data, CNKI, Cqvip and CBM for Meta-analysis. The cut-off time for searching was July 25, 2015. RevMan software designed by Cochrane cooperation network was used for statistical analysis. The major outcomes indexes were preoperative and postoperative levels of platelet, leukocyte and hemoglobin. The secondary outcomes indexes were operative time, intraoperative bleeding and hospital stay.Results A total of 10 studies were selected. Meta-analysis showed the levels of platelet (mean difference[MD] -87.68, 95%CI[-125.70, -49.65]), leukocyte (MD -4.03, 95%CI[-5.74, -2.33]) and hemoglobin (MD -0.79, 95%CI[-1.48, -0.11]) after PSE treatment were higher than those before, and the levels of platelet (MD -128.31, 95%CI[-162.59, -94.03]), leukocyte (MD -5.22, 95%CI[-6.65, -3.80]) and hemoglobin (MD -1.42, 95%CI[-2.66, -0.18]) after splenectomy were higher than those before the operation. The differences of platelet (MD 54.45, 95%CI[37.60, 71.30]), leukocyte (MD 1.71, 95%CI[-0.01,3.42]) and hemoglobin (MD 0.78, 95%CI[-0.01, 1.56]) between postoperative and preoperative levels for PSE was lower than those for splenectomy. Compared with splenectomy, PSE exhibited less intraoperative bleeding (MD -71.33, 95%CI[-78.13, -64.54]), shorter operative time (MD -34.08, 95%CI[-34.78, -33.38]) and shorter length of stay (MD -5.59,95%CI[-7.38, -3.79]). Conclusion PSE is a mini-invasive therapy, which can be used to effectively treat hypersplenism secondary to liver cirrhosis.
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