摘要
目的系统评价部分脾动脉栓塞术(partial splenic artery embolization,PSE)与脾切除术治疗肝硬化脾功能亢进的疗效。方法通过检索PubMed、Cochrane Library、Embase、中国知网、万方数据知识服务平台等数据库,收集自建库以来至2021年10月30日关于PSE与脾切除术治疗肝硬化脾功能亢进的随机对照试验和队列研究,由两位研究员分别独立筛选文献、提取资料和评价偏倚风险后进行统计分析。结果共纳入14篇文献,1092例患者,Meta分析结果显示,两组术后1周、1个月、1年白细胞计数水平比较,差异均无统计学意义(P>0.05),术后6个月(MD=-2.03,95%CI:-3.03~-1.04,P<0.001)脾切除术组明显高于PSE组;两组术后1个月、1年血小板计数比较,差异无统计学意义(P>0.05);术后1周(MD=-65.46,95%CI:-116.39~-14.52,P=0.01)和术后6个月(MD=-117.99,95%CI:-229.71~-6.27,P=0.04)脾切除术组均高于PSE组;两组术后1周、1个月和1年红细胞计数水平比较,差异均无统计学意义;两组患者NK细胞计数水平比较,术后1个月(MD=6.02,95%CI:4.27~7.77,P<0.001)、术后1年(MD=3.53,95%CI:1.68~5.37,P=0.0002),均提示PSE组的术后自然杀伤细胞计数水平明显高于脾切组;与脾切除术组比较,PSE组术中出血量更少(MD=-73.92,95%CI:-89.39~-58.45,P<0.001)、住院费用更少(MD=-0.80,95%CI:-1.27~-0.34,P=0.0008)、住院时间也更短(MD=-4.08,95%CI:-5.22~-2.95,P<0.001)。结论现有证据表明,PSE治疗肝硬化脾功能亢进短期与远期均有一定的疗效,相较于脾切除术,其手术创伤小,住院时间和费用少,并发症易控制,且可保留一定的免疫功能,更值得在临床应用推广。受纳入文献数量以及质量的限制,上述结论仍需开展更多高质量研究予以验证。
Objective To systematically evaluate the efficacy of partial splenic artery embolization(PSE)and splenectomy in the treatment of secondary hypersplenism in liver cirrhosis.Methods PubMed,Cochrane Library,Embase,CNKI,Wan Fang were searched to collect randomized controlled trials and cohort studies about the efficacy of PSE versus splenectomy in the treatment of hypersplenism secondary to liver cirrhosis from inception to October 30,2021.Two reviewers screened the literature,extracted data,and assessed the risk of bias of included studies.Meta-analysis was then conducted.Results A total of 14studies were included with 1092 patients.The results of the meta-analysis showed that there was no significant difference in postoperative leukocyte levels at 1 week,1month,and 1 year after surgery between the PSE group and the splenectomy group.However,6months after surgery,the level of postoperative leukocyte in the splenectomy group was significantly higher than that in the PSE group.For postoperative platelet counts,there was no significant difference at 1month and 1 year after surgery between the two groups.However,1 week(MD=-65.46,95%CI:-116.39--14.52,P=0.01)and 6months(MD=-117.99,95%CI:-229.71--6.27,P=0.04)after surgery,the level of postoperative platelet in splenectomy group was significantly higher than that in PSE group.There was no significant difference in postoperative erythrocyte levels at 1 week,1month,and 1 year after surgery between the two groups.The level of postoperative natural killer cells in the PSE group was significantly higher than that in the splenectomy group at 1month(MD=6.02,95%CI:4.27-7.77,P<0.001)and 1 year(MD=3.53,95%CI:1.68-5.37,P=0.0002)after surgery.Compared with splenectomy group,PSE group exhibited less intraoperative bleeding(MD=-73.92,95%CI:-89.39--58.45,P<0.001),less hospitalization costs(MD=-0.80,95%CI:-1.27--0.34,P=0.0008)and shorter length of stay(MD=-4.08,95%CI:-5.22--2.95,P<0.001).Conclusion The current evidence shows that PSE has certain short-term and long-term effects on hyperspl
作者
张志强
蒲莹
陈伟
刘波
ZHANG Zhiqiang;PU Ying;CHEN Wei(Department of Gastroenterology,Xiangyang No.1 People′s Hospital,Hubei University of Medicine,Hubei 441000,China)
出处
《医学研究杂志》
2024年第1期80-87,97,共9页
Journal of Medical Research
基金
湖北省自然科学基金资助项目(2018CFB619)。
