Patency and clinical outcomes of transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stents versus bare stents: A meta-analysis

被引:118
|
作者
Yang, Zhiping [1 ]
Han, Guohong [1 ]
Wu, Qiong [1 ]
Ye, Xiaofei [2 ]
Jin, Zhichao [2 ]
Yin, Zhanxin [1 ]
Qi, Xingshun [1 ]
Bai, Ming [1 ]
Wu, Kaichun [1 ]
Fan, Daiming [1 ]
机构
[1] Fourth Mil Med Univ, Xijing Hosp Digest Dis, Xian 710032, Peoples R China
[2] Second Mil Med Univ, Dept Hlth Stat, Shanghai, Peoples R China
基金
中国国家自然科学基金;
关键词
hepatic encephalopathy; portal hypertension; shunt dysfunction; FOLLOW-UP; TIPS; GRAFTS; CREATION; SURVEILLANCE; DYSFUNCTION; MANAGEMENT; SURVIVAL;
D O I
10.1111/j.1440-1746.2010.06400.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and Aim: Transjugular intrahepatic portosystemic shunt (TIPS) with polytetrafluoroethylene-(PTFE)-covered stent has been increasingly used for patients with complications of portal hypertension. It is still debated whether the new endoprostheses will improve some clinical outcomes (except for shunt patency) compared to the bare stents. The aims of our meta-analysis were to explore the patency and clinical outcomes of TIPS with PTFE-covered stent-grafts versus bare stents. Methods: Pertinent studies were retrieved through PubMed (1950-2010), MEDLINE (1950-2010), and reference lists of key articles. Outcome measures were primary patency, risk of encephalopathy and survival. Time-to-event data analysis was used to calculate the overall hazard ratios (HR). Results: Six studies were identified including a total of 1275 patients (346 TIPS with PTFE-covered stent-grafts and 929 TIPS with bare stents). Pooled shunt patency data from four eligible studies suggested a significant improvement of primary patency in patients who were treated with PTFE-covered stent-grafts (HR = 0.28, 95% confidence interval [CI] 0.20-0.35). Pooled encephalopathy data from three eligible studies suggested a significant reduction of risk in the PTFE-covered group (HR = 0.65, 95%CI 0.45-0.86). Pooled survival data from four eligible studies also suggested a significant decrease of mortality in the PTFE-covered group (HR = 0.76, 95%CI 0.58-0.94). No statistical heterogeneity was observed between studies for either outcome. Conclusions: This meta-analysis shows that the use of PTFE-covered stent-grafts clearly improves shunt patency without increasing the risk of hepatic encephalopathy and with a trend towards better survival.
引用
收藏
页码:1718 / +
页数:8
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