Abstract：
BACKGROUND: Budd-Chiari syndrome (BCS) results from the obstruction of the hepatic venous flow, usually at the level of the hepatic vein or inferior vena cava. When left untreated, it can progress with several complications, including liver cirrhosis. Transjugular intrahepatic portosystemic shunt (TIPS) appears to be effective in a subgroup of BCS patients.
OBJECTIVE: To perform a systematic review and meta-analysis of TIPS effectiveness in BCS treatment, considering the survival rate, reduction in portosystemic pressure, need for liver transplantation, technical failure, and shunt dysfunction for up to 10 years of follow-up.
METHODS: We evaluated 17 studies published in PubMed, Science Direct, Web of Science, and SCOPUS databases, which used TIPS as a treatment for BCS, comprising 618 subjects between 18 and 78 years old. We assessed the bias risk by the NOS, NHI, and JBI scales for cohort stu-dies, before-after studies, and case series, respectively. We conducted the meta-analyses by extracting the number of events and the total patients evaluated to perform the proportion meta-analyses using the R software (\"meta\" package - version 4.9-6).
RESULTS: The pooled results (95%CI) showed a 19% (25.9-12.5%) rate of portosystemic pressure reduction, 6% (1-12%) rate for the need for liver transplants despite the use of TIPS, 2% (1-6%) technical failure rate, 30% (18-46%) shunt dysfunction rate, and 88% (81-93%) for the mean frequency of patients alive between 1 and 10 years after the procedure. We stratified survival rate and found an 86% (74-93%) prevalence of living subjects during less than five years, 92% (83-97%) at five years, and a 77% frequency (68-83%) of patients alive ten years after the TIPS placement.
CONCLUSIONS: TIPS is an effective treatment for BCS, providing a high 10-year frequency of living patients and a significant decrease in portosystemic pressure. The need for liver transplants after TIPS and the technical failure rate is low.
OBJECTIVE: To perform a systematic review and meta-analysis of TIPS effectiveness in BCS treatment, considering the survival rate, reduction in portosystemic pressure, need for liver transplantation, technical failure, and shunt dysfunction for up to 10 years of follow-up.
METHODS: We evaluated 17 studies published in PubMed, Science Direct, Web of Science, and SCOPUS databases, which used TIPS as a treatment for BCS, comprising 618 subjects between 18 and 78 years old. We assessed the bias risk by the NOS, NHI, and JBI scales for cohort stu-dies, before-after studies, and case series, respectively. We conducted the meta-analyses by extracting the number of events and the total patients evaluated to perform the proportion meta-analyses using the R software (\"meta\" package - version 4.9-6).
RESULTS: The pooled results (95%CI) showed a 19% (25.9-12.5%) rate of portosystemic pressure reduction, 6% (1-12%) rate for the need for liver transplants despite the use of TIPS, 2% (1-6%) technical failure rate, 30% (18-46%) shunt dysfunction rate, and 88% (81-93%) for the mean frequency of patients alive between 1 and 10 years after the procedure. We stratified survival rate and found an 86% (74-93%) prevalence of living subjects during less than five years, 92% (83-97%) at five years, and a 77% frequency (68-83%) of patients alive ten years after the TIPS placement.
CONCLUSIONS: TIPS is an effective treatment for BCS, providing a high 10-year frequency of living patients and a significant decrease in portosystemic pressure. The need for liver transplants after TIPS and the technical failure rate is low.
摘要：
背景：Budd-Chiari综合征（BCS）是肝静脉血流阻塞的结果，通常在肝静脉或下腔静脉的水平。如果不及时治疗，它可以发展几个并发症，包括肝硬化.经颈静脉肝内门体分流术（TIPS）在BCS患者亚组中似乎有效。
目的：对TIPS在BCS治疗中的有效性进行系统评价和荟萃分析，考虑到存活率，门体压力降低，需要肝移植，技术故障,和分流功能障碍长达10年的随访。
方法：我们评估了发表在PubMed上的17项研究，科学直接，WebofScience,和SCOPUS数据库，使用TIPS作为BCS的治疗方法，包括618名18至78岁的受试者。我们通过NOS评估偏倚风险，NHI,和队列研究人员的JBI量表，前后研究，和案例系列，分别。我们通过提取事件数量和评估的患者总数进行荟萃分析，以使用R软件（“meta”软件包-4.9-6版）进行比例荟萃分析。
结果：合并结果（95CI）显示门体压力降低19％（25.9-12.5％），尽管使用TIPS，但需要肝移植的比率为6％（1-12％），2％（1-6％）的技术故障率，30%（18-46%）分流功能障碍率，手术后1至10年存活患者的平均频率为88％（81-93％）。我们对生存率进行了分层，发现在不到五年的时间内，活体受试者的患病率为86％（74-93％）。92％（83-97％）在五年，和77％的频率（68-83％）的患者在TIPS放置后十年存活。
结论：TIPS是治疗BCS的有效方法，提供了一个高的10年频率的生活患者和显著降低门体压力。TIPS后需要肝移植，技术失败率低。
目的：对TIPS在BCS治疗中的有效性进行系统评价和荟萃分析，考虑到存活率，门体压力降低，需要肝移植，技术故障,和分流功能障碍长达10年的随访。
方法：我们评估了发表在PubMed上的17项研究，科学直接，WebofScience,和SCOPUS数据库，使用TIPS作为BCS的治疗方法，包括618名18至78岁的受试者。我们通过NOS评估偏倚风险，NHI,和队列研究人员的JBI量表，前后研究，和案例系列，分别。我们通过提取事件数量和评估的患者总数进行荟萃分析，以使用R软件（“meta”软件包-4.9-6版）进行比例荟萃分析。
结果：合并结果（95CI）显示门体压力降低19％（25.9-12.5％），尽管使用TIPS，但需要肝移植的比率为6％（1-12％），2％（1-6％）的技术故障率，30%（18-46%）分流功能障碍率，手术后1至10年存活患者的平均频率为88％（81-93％）。我们对生存率进行了分层，发现在不到五年的时间内，活体受试者的患病率为86％（74-93％）。92％（83-97％）在五年，和77％的频率（68-83％）的患者在TIPS放置后十年存活。
结论：TIPS是治疗BCS的有效方法，提供了一个高的10年频率的生活患者和显著降低门体压力。TIPS后需要肝移植，技术失败率低。
