比较内镜套扎与硬化剂预防肝硬化食管静脉曲张再出血：Meta分析

doi:10.3969/j.issn.1006-7795.2013.05.008

首都医科大学学报 ›› 2013, Vol. 34 ›› Issue (5): 673-678.doi: 10.3969/j.issn.1006-7795.2013.05.008

比较内镜套扎与硬化剂预防肝硬化食管静脉曲张再出血：Meta分析

陈明锴¹, 何千榆¹, 丁百静², 刘云燕¹

1. 武汉大学人民医院消化内科, 武汉 430060;
2. 芜湖市第二人民医院消化内科, 安徽芜湖 241000

收稿日期:2013-03-05 出版日期:2013-10-21 发布日期:2013-10-22
通讯作者: 丁百静 E-mail:xuejixiu1@163.com
基金资助:
国家中医药管理局中医药行业科研专项资助项目(201007006);北京市卫生系统高层次卫生技术人才项目;北京市优秀人才培养资助项目(2012D003034000011)。

Comparison of endoscopic ligation with sclerotherapy for preventing cirrhosis esophageal varices bleeding：a Meta analysis

CHEN Mingkai¹, HE Qianyu¹, DING Baijing², LIU Yunyan¹

1. Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China;
2. Department of Gastroenterology, the Second Renmin Hospital of Wuhu, Wuhu 241000, Anhui province, China

Received:2013-03-05 Online:2013-10-21 Published:2013-10-22
Supported by:
This study was supported by the National Administration of Traditional Chinese Medicine Research Funding Project (201007006);Beijing Health Technical Personnel Project, and Beijing municipal Foundation for the Excellent Talents(2012D003034000011).

摘要/Abstract

摘要：

目的通过分析比较套扎与硬化注射对食管静脉曲张出血患者的疗效,评价两者在二级预防中的价值。方法检索Springer、Pubmed、Sinomed、CNKI、Cochrane Library,万方等数据库,用Cochrane图书馆的RevMan5.1软件进行Meta分析。结果共纳入7项随机对照试验,结果显示, 套扎治疗后再出血发生率显著低于硬化治疗(OR=0.54,95%CI:0.38~0.76,Z=3.56,P=0.000);在降低病死率方面两者疗效相似(OR=0.79,95%CI:0.55~1.14,Z=1.27,P=0.21);套扎组较硬化组能明显减少合并症(OR=0.22,95%CI:0.13~0.38,Z=5.51,P=0.000);两组在消除静脉曲张方面效果等同(OR=1.46,95%CI:0.98~2.18,Z=1.88,P=0.060)。制作漏斗图分析发表偏倚,图中落点分布比较对称,表明本研究对纳入文献评价的发表偏倚较小。结论套扎较硬化注射在食管静脉曲张出血二级预防中疗效更佳,套扎治疗在一般情况下更适合食管静脉曲张出血的二级预防。

关键词: 食管静脉曲张出血, 二级预防, 硬化, 套扎, Meta分析

Abstract:

Objective To evaluate the efficacy of endoscopic variceal ligation (EVL) and sclerotherapy (EVS) for obliteration of esophageal varices among patients who survived an episode of first variceal hemorrhage. Methods The related literature was identified from Pubmed, Medline, Embase, CNKI, the library of Cochrane, and Wanfang database. RevMan 5.1 Software provided by the Library of Cochrane was used for Meta-analysis. Results A total of 7 randomized controlled trials were included. It was shown that the rehemorrhage rate of EVL was significantly lower than that of EVS (OR=0.54,95% CI:0.38－0.76,Z = 3.56,P = 0.000 4); Meanwhile, there was no significant difference in mortality between EVL and EVS (OR=0.79,95% CI:0.55－1.14,Z =1.27,P = 0.21). Compared with EVS, EVL could significantly reduce the complications of treatment (OR=0.22,95% CI:0.13－0.38,Z = 5.51,P=0.000 01); there was no significant difference in obliteration of varices between EVL and EVS (OR=1.46,95% CI:0.98－2.18,Z =1.88, P =0.06). Little publication bias was found with funnel plot analysis. Conclusion EVL is better than EVS in the prevention of rehemorrhagia of esophageal varices and it is the first choice for secondary prophylaxis.

Key words: esophageal varices bleeding, secondary prophylaxis, sclerotherapy, ligation, Meta analysis

中图分类号:

R571.3

陈明锴, 何千榆, 丁百静, 刘云燕. 比较内镜套扎与硬化剂预防肝硬化食管静脉曲张再出血：Meta分析[J]. 首都医科大学学报, 2013, 34(5): 673-678.

CHEN Mingkai, HE Qianyu, DING Baijing, LIU Yunyan. Comparison of endoscopic ligation with sclerotherapy for preventing cirrhosis esophageal varices bleeding：a Meta analysis[J]. Journal of Capital Medical University, 2013, 34(5): 673-678.

参考文献

[1] Garcia-Pagan J C, De Gottardi A, Bosch J. Review article: the modern management of portal hypertension-primary and secondary prophylaxis of variceal bleeding in cirrhotic patients[J]. Aliment Pharmacol Ther,2008, 28(2):178-186.
[2] Garcya-Pagan J C, Villanueva C, Albillos A, et al. Nadolol plus isosorbide mononitrate alone or associated with band ligation in the prevention of recurrent bleeding: A multicentre randomised controlled trial[J]. Gut,2009,58(8):1144-1450.
[3] Villanueva C, Minana J, Ortiz J, et al. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding[J]. N Engl J Med,2001,345(9):647-655.
[4] Ferrari A P, de Paulo G A,de Macedo C M,et al.Efficacy of absolute alcohol injection compared with band ligation in the eradication of esophageal varices[J].Arq Gastroenterol,2005,42(2):72-76.
[5] Masci E, Stigliano R, Mariani A,et al. Prospective multicenter randomized trial comparing banding ligation with sclerotherapy of esophageal varices[J]. Hepatogastroenterology, 1999, 46(27):1769-1773.
[6] Baroncini D,Milandri G L,Borioni D,et al.A prospective randomized trial of sclerotherapy versus ligation in the elective treatment of bleeding esophageal Varices[J].Endoscopy,1997,29(4):235-240.
[7] Liu D L,Huo J R,Wu X P,et al. Comparative clinical study of ligation versus sclerothetapy in the treatment of bleeding esophageal varices[J]. Hunan Medical,1999,16(2): 90-91.
[8] De la Pena J,Rivero M,Sanchez E,et al.Variceal ligation compared with Endoscopic sclerotherapy for variceal hemorrhage: prospective randomized Trial[J]. Gastrointest Endosc,1999,49(4):417-423.
[9] Hou M C, Lin H C, Kuo B I,et al. Comparison of endoscopic variceal injection sclerotherapy and ligation for the treatment of esophageal variceal hemorrhage: a prospective randomized trial[J]. Hepatology,1995,21(6):1517-1522.
[10] Lo G H, Lai K H, Cheng J S, et al.A prospective,randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices[J]. Hepatology,1995,22(2):466-471.
[11] Committee of esophageal varicosity,Society of digestive Endoscopy of Chinese Medical Association. Tentative guidelines for endoscopic diagnosis and treatment of varicosity and variceal bleeding in digestive tract(2009)[J]. Chin J Gig Endosc, 2010, 27(1): 1-4.
[12] Baron T H, Wong Kee, Song L M. Endoscopic variceal band ligation[J]. Am J Gastroenterol,2009,104(5):1083-1085.
[13] Garcia-Tsao G, SanyalA J, G race N D, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage incirrhosis[J]. Hepatology, 2007,46:(3)922-938.
[14] 潘黎明,毛晓燕,曹唯.无痛内镜下治疗食管静脉曲张的护理[J].临床误诊误治,2010,23(10):44-45.
[15] 陈强,刘迎娣.内镜下组织黏合剂联合硬化剂注射治疗食管胃底静脉曲张的疗效观察[J].中国煤炭工业医学杂志,2012,15(2):214-215.

比较内镜套扎与硬化剂预防肝硬化食管静脉曲张再出血：Meta分析

Comparison of endoscopic ligation with sclerotherapy for preventing cirrhosis esophageal varices bleeding：a Meta analysis

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