摘要
目的比较内镜下钛夹辅助组织胶注射与球囊阻塞逆行经静脉闭塞术(balloon-occluded retrograde transvenous obliteration,BRTO)治疗胃底静脉曲张的疗效及安全性。方法计算机检索Cochrane Library、PubMed、EmBase、万方数据、中国知网、中国生物医学数据库,检索所有涉及“钛夹辅助组织胶注射”、“球囊阻塞逆行经静脉闭塞”的随机对照研究、队列研究及病例对照研究,检索时限为建库至2022年4月1日。由2位研究者筛选文献、提取数据、评价纳入文献的偏倚风险,采用ADDIS 1.16.7软件进行网状Meta分析。结果共纳入14篇文献,1249例患者。经统计发现:在预防再出血方面,BRTO成为最佳干预措施的概率为99%,且钛夹辅助组与BRTO组比较,差异有统计学意义(OR=3.45,95%CI:1.25~9.48);在预防异位栓塞方面,钛夹辅助组成为最佳干预措施的概率为64%,但钛夹辅助组与BRTO组比较,差异无统计学意义(OR=0.57,95%CI:0.03~11.37);在胃底静脉曲张消失方面,钛夹辅助组成为最佳干预措施的概率为88%,但钛夹辅助组与BRTO组比较,差异无统计学意义(OR=7.76,95%CI:0.26~538.32)。结论与内镜下钛夹辅助组织胶注射相比,BRTO治疗在预防胃底静脉曲张再出血方面更具有优势,值得推广。
Objective To compare efficacy and safety between clip-assisted endoscopic cyanoacrylate injection and balloon-occluded retrograde transvenous obliteration(BRTO)in gastric fundal varices.Methods Electronic databases,including Cochrane Library,PubMed,EmBase,WanFang data,CNKI and CBM,were searched to collect all case-controlled trials about″clip-assisted endoscopic cyanoacrylate injection″and″balloon-occluded retrograde transvenous obliteration″from inception to Apr.1st,2022.Literature review,data extraction,and risk of bias evaluation were performed by two researchers.ADDIS 1.16.7 was used for network Meta-analysis.Results 14 articles were included in this study which contained 1249 patients in totally.In preventing re-bleeding,BRTO had 99%probability to be the best intervention,and the difference between clip-assisted group and BRTO group was statistically significant(OR=3.45,95%CI:1.25-9.48).In preventing ectopic embolism,clip-assisted group had 64%probability to be the best intervention,but the difference between two groups was not statistically significant(OR=0.57,95%CI:0.03-11.37).In eradication rate of gastric fundus varices,clip-assisted group had 88%probability to be the best intervention,the difference between two groups was still not statistically significant(OR=7.76,95%CI:0.26-538.32).Conclusion Compared with clip-assisted endoscopic cyanoacrylate injection,BRTO has more advantage to preventing gastric fundal varices rebleeding and is worth of popularization.
作者
周智勇
张明君
黄勍
刘金哲
任渝棠
蒋绚
李恕军
ZHOU Zhiyong;ZHANG Mingjun;HUANG Qing;LIU Jinzhe;REN Yutang;JIANG Xuan;LI Shujun(Department of Gastroenterology,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102218,China)
出处
《胃肠病学和肝病学杂志》
CAS
2023年第6期646-652,共7页
Chinese Journal of Gastroenterology and Hepatology
关键词
胃底静脉曲张
钛夹
组织胶
球囊阻塞逆行经静脉闭塞术
网状Meta分析
Gastric fundal varices
Clip
Cyanoacrylate injection
Balloon-occluded retrograde transvenous obliteration
Network Meta-analysis
