Prophylactic Use of Transjugular Intrahepatic Portosystemic Shunt Aids in the Treatment of Refractory Ascites

医学 腹水 肝性脑病 经颈静脉肝内门体分流术 内科学 置信区间 胃肠病学 优势比 穿刺 随机对照试验 门脉高压 子群分析 外科 肝硬化
作者
Ren Pin Chen,Xiao Ju Zhu Ge,Zhi Ming Huang,Xiao Hua Ye,Chang Yuan Hu,Guang Rong Lu,De Yi Lu,Igor Longe Phemba
出处
期刊:Journal of Clinical Gastroenterology [Lippincott Williams & Wilkins]
卷期号:48 (3): 290-299 被引量:30
标识
DOI:10.1097/mcg.0b013e3182a115e9
摘要

The aim of this study was to explore whether prophylactic use of transjugular intrahepatic portosystemic shunt (TIPS) could aid in the treatment of refractory ascites on the basis of current randomized controlled trials.TIPS is more effective for refractory ascites versus large-volume paracentesis. At present, however, the survival advantage is not clear within populations of undifferentiated patients.Correlative studies were searched through online journal databases, and a manual search was done from 1974 to 2012. Six trials involving 390 patients were included.TIPS could ameliorate refractory ascites on the basis of short-term analysis [odds ratio (OR) 8.66; 95% confidence interval (CI), 5.27-14.24] and long-term analysis (OR 6.07; 95% CI, 3.60-10.22). Hepatic encephalopathy (HE) appeared more common in the TIPS arm (OR 2.95; 95% CI, 1.87-4.66). Mortality in the 2 groups did not show any difference (OR 0.82; 95% CI, 0.46-1.50). Trial sequential analysis confirmed the effect of TIPS upon ascites control and upon the risk of HE recurrence, whereas insufficient trials were available to distinguish between the arms on mortality. Metaregression analysis showed that the level of urine sodium, serum bilirubin, and portal pressure gradient reduction value could be used as survival predictors. Subgroup analysis showed an elevated survival effect in TIPS (OR 0.45; 95% CI, 0.24-0.81), and patients survived longer with recurrent ascites (OR 0.40; 95% CI, 0.19-0.83).TIPS was confirmed to improve ascites control in both the short term and the long term. Although HE frequently appeared in the TIPS group, patients with better hepatic and renal function survived longer when they were treated with TIPS. Serum bilirubin and urine sodium could be used as pre-TIPS predictors for patient survival. Portal pressure gradient reduction values could be used as post-TIPS predictors of survival.
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