■左侧门静脉高压(LSPH)导致危及生命的胃肠道(GI)出血。关于LSPH引起的消化道出血的处理没有建议或共识。进行了系统评价和荟萃分析,以评估接受不同治疗策略的LSPH患者的胃肠道出血发生率和死亡率。
■进行了系统评价和荟萃分析,以确定不同治疗策略对LSPH引起的消化道出血的疗效。
■所有相关研究均来自PubMed,Embase,WebofScience,科克伦图书馆,Scopus,ScienceDirect,MEDLINE,谷歌学者,CNKI,到2023年11月15日,万方数据没有语言限制。通过RevMan5.3软件计算赔率(ORs)和95%置信区间(CIs)。(科克伦合作,哥本哈根,丹麦)。
■17项回顾性研究和1项前瞻性研究纳入624例患者。这项系统评价和荟萃分析发现:(1)脾切除术比非脾切除术治疗策略在减少由LSPH引起的胃肠道出血的发生率方面更有效(OR:0.12;95%CI:0.06-0.27);(2)脾切除术优于部分脾动脉栓塞(PSAE)(OR:0.06;95%CI:0.01-0.62)或内镜干预(OR:0.04;95%CI:0.01-0.19)(3)脾切除术和非脾切除术治疗策略的死亡率无显著差异(OR:0.46;95%CI:0.20-1.08);(4)术前PSAE后脾切除术患者的术中出血少,手术时间短.
■这项荟萃分析表明,在减少LSPH消化道出血的发生率方面,脾切除术优于非脾切除术治疗策略。这表明在这些患者的治疗中应推荐脾切除术。
■本研究已在PROSPERO数据库上注册,注册号为CRD42023483764。
UNASSIGNED: Left-sided portal hypertension (LSPH) leads to life-threatening gastrointestinal (GI) bleeding. There are no recommendations or consensus about the management of GI bleeding caused by LSPH. This systematic review and meta-analysis were conducted to evaluate the incidence of GI bleeding and the mortality of patients with LSPH receiving different therapeutic strategies.
UNASSIGNED: A systematic review and meta-analysis were performed to determine the efficacy of different therapeutic strategies for GI bleeding caused by LSPH.
UNASSIGNED: All relevant studies were searched from PubMed, Embase, Web of Science, Cochrane Library, Scopus, ScienceDirect, MEDLINE, Google Scholar, CNKI, and Wanfang Data without language restriction through 15 November 2023. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated through RevMan5.3 software. (The Cochrane Collaboration, Copenhagen, Denmark).
UNASSIGNED: Seventeen retrospective studies and one prospective study involving 624 patients were included. This systematic review and meta-analysis found that: (1) splenectomy was more effective than non-splenectomy therapeutic strategies in reducing the incidence of GI bleeding caused by LSPH (OR: 0.12; 95% CI: 0.06-0.27); (2) splenectomy was superior to partial splenic artery embolism (PSAE) (OR: 0.06; 95% CI: 0.01-0.62) or endoscopic interventions (OR: 0.04; 95% CI: 0.01-0.19) in the prevention of GI bleeding, respectively; (3) no significant difference in the mortality was observed between splenectomy and non-splenectomy therapeutic strategies (OR: 0.46; 95% CI: 0.20-1.08); and (4) patients receiving preoperative PSAE followed by splenectomy had less intraoperative bleeding and shorter operative time than those receiving splenectomy.
UNASSIGNED: This meta-analysis demonstrated that splenectomy is superior to non-splenectomy therapeutic strategies in reducing the incidence of GI bleeding from LSPH, which revealed that splenectomy should be recommended in the management of these patients.
UNASSIGNED: This study has been registered on the PROSPERO database with the registration number CRD42023483764.