本文選題：肝硬化 + 食管胃底曲張靜脈出血��； 參考：《重慶醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:通過系統(tǒng)評價(jià)比較在預(yù)防肝硬化曲張靜脈破裂再出血方面,經(jīng)頸靜脈肝內(nèi)門體分流術(shù)(Transjugular Intrahepatic Portosystemic Shunt,TIPS)與內(nèi)鏡治療(Endoscopic Therapy,ET)的臨床效果。方法:通過計(jì)算機(jī)檢索PubMed、Embase、Web of science、The Cochrane Library、Medline、CBM、萬方、知網(wǎng)等數(shù)據(jù)庫,根據(jù)嚴(yán)格納入排除標(biāo)準(zhǔn),將建庫至2015年7月以前發(fā)表的關(guān)于預(yù)防肝硬化曲張靜脈再出血的隨機(jī)對照試驗(yàn)(Randomized controlled trial,RCT)納入本次研究,采用Rev Man 5.2軟件對納入試驗(yàn)進(jìn)行薈萃分析。結(jié)果:共納入16篇高質(zhì)量RCT,其中TIPS組659例,ET組644例。Meta分析結(jié)果顯示:與ET相比,TIPS能更好地控制肝硬化曲張靜脈再出血率及因再出血所致死亡率(RR=0.41,95%CI:0.35~0.49,P0.00001;RR=0.38,95%CI:0.24~0.59,P0.0001)。TIPS術(shù)后肝性腦病的發(fā)生率明顯高于ET(RR=1.62,95%CI:1.35~1.95,P0.00001)。就總體病死率、住院總天數(shù)而言,TIPS和ET差異無統(tǒng)計(jì)學(xué)意義(RR=1.01,95%CI:0.83~1.23,P=0.93;MD=0.84,95%CI:-1.33~3.02,P=0.45)。結(jié)論:TIPS術(shù)后肝硬化曲張靜脈再出血率低于內(nèi)鏡治療,但并未改善患者總體生存率,且術(shù)后肝性腦病發(fā)生率較高。TIPS在某些情況下可作為預(yù)防肝硬化曲張靜脈再出血治療的優(yōu)先選擇。
[Abstract]:Objective: to evaluate and compare the clinical effects of Transjugular Intrahepatic Portosystemic shunt (TIPS) and endoscopy in the prevention of rebleeding of variceal varices in liver cirrhosis. Methods: we searched the Cochrane Library Medline (CBM), Wanfang (Wanfang), Knownet and other databases by computer, according to the criteria of strict inclusion, exclusion, and so on. A randomized controlled trial on preventing rebleeding of varicose veins in liver cirrhosis, published before July 2015, was included in this study. Rev Man 5.2 software was used to conduct a meta-analysis of the inclusion trial. Results: a total of 16 high quality RCTs were included, of which 659 cases in TIPS group and 644 cases in et group. Meta-analysis showed that tips could better control the rate of rebleeding of varicose veins in liver cirrhosis and the mortality rate caused by rebleeding in cirrhotic patients compared with et. The incidence rate was significantly higher than that of ETR RV 1.6295 and CI: 1.35 1.95% P0.00001. There was no significant difference between tips and et in terms of total hospitalization days. There was no significant difference between RRN 1.01and 95% CI: 0.83 (1.23), P0.93 (0.93%) and CI-1: -1.33 (3.02) P 0.45% (CI: -1.33) 3.02% (P = 0.45). Conclusion the rebleeding rate of varicose veins in liver cirrhosis after the operation of TIPS is lower than that of endoscopic therapy, but it does not improve the overall survival rate of the patients. The incidence of hepatic encephalopathy after operation is higher. Tips may be the first choice in the treatment of hepatic cirrhosis variceal rebleeding in some cases.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R575.2

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