腔内外联合断流术与单纯断流术治疗食管胃静脉曲张有效性和安全性的Meta分析

Efficacy and Safety of Splenectomy and Pericardial Devascularization Combined with Endoscopic Intervention versus Simple Devascularization in the Treatment of Esophagogastric Varices: A Meta-Analysis

摘要: 目的：系统评价脾切除加贲门周围血管离断术联合内镜干预治疗食管胃静脉曲张的有效性和安全性。方法：检索中国生物医学文献服务系统、中国知网、万方数据知识服务平台、维普期刊全文数据库、PubMed、MEDLINE、Web of Science及Embase等数据库，检索时间均从建库至2023年04月，收集关于腔内外联合断流术(消化内镜联合脾切除加贲门周围血管离断术)和单纯脾切除加贲门周围血管离断术治疗GOV的随机对照试验和队列研究，采用Review Manager 5.3和Stata 12.0软件进行Meta分析。结果：最终纳入10篇文献。纳入研究对象803例，其中联合组(腔内外联合断流术治疗) 419例，手术组(单纯脾切除加贲门周围血管离断术治疗) 384例。Meta分析结果显示，联合组术后再出血率低于手术组(RR = 0.17, 95% CI: 0.10~0.31, P < 0.00001)，两组患者在术后并发症总发生率(RR = 0.93, 95% CI: 0.79~1.10, P = 0.39)、术后住院期间死亡率(RR = 0.74, 95% CI: 0.30~1.83, P = 0.52)及术后随访期间死亡率(RR = 0.69, 95% CI: 0.30~1.62, P = 0.40)方面无明显差异。敏感性分析显示，结果稳定性较好。结论：脾切除加贲门周围血管离断术联合内镜干预能有效降低术后食管胃静脉曲张出血率，安全性与单纯脾切断流术相比无差异。

Abstract: Objective: To evaluate the efficacy and safety of splenectomy and pericardial devascularization combined with endoscopic intervention in the treatment of esophagogastric varices. Methods: Ran-domized controlled trials and cohort studies about the treatments of esophagogastric varices pa-tients with splenectomy and pericardial devascularization combined with endoscopic intervention and simple devascularization were collected through searching CBM, CNKI, Wanfang Data, VIP, PubMed, MEDLINE, Web of Science and Embase databases from inception to April 2023. Me-ta-analysis was performed by using Review Manager 5.3 and Stata 12.0. Results: A total of 10 arti-cles and 803 subjects were included. 419 subjects were treated with splenectomy and pericardial devascularization combined with endoscopic intervention in the combined group and 384 subjects were treated with simple devascularization in the surgical group. The meta-analysis showed that the postoperative esophagogastric varices rebleeding rate in the combined group was lower than that in the surgical group (RR = 0.17, 95% CI: 0.10~0.31, P < 0.00001). There were no significant differences between the two groups in the total incidence of postoperative complications (RR = 0.93, 95% CI: 0.79~1.10, P = 0.39), in-hospital mortality (RR = 0.74, 95% CI: 0.30~1.83, P = 0.52) and fol-low-up mortality (RR = 0.69, 95% CI: 0.30~1.62, P = 0.40). Sensitivity analysis showed that the re-sults were stable. Conclusions: Splenectomy and pericardial devascularization combined with en-doscopic intervention can effectively reduce the postoperative esophagogastric varices rebleeding rate, and there is no difference in safety compared with simple devascularization.