内镜下套扎与硬化剂治疗食管静脉曲张破裂出血疗效的Meta分析

目的系统评价内镜下套扎疗法(EVL)与硬化剂治疗(EVS)食管静脉曲张破裂出血的疗效与安全性。方法全面检索Pubmed、Web of Science、The Cochrane Library(2016年2期)、CNKI、Wan Fang Data数据库,检索时限均为1980年1月-2016年3月,纳入内镜下治疗食管静脉曲张破裂出血的随机对照试验,采用Rev Man5.3软件进行Meta分析。结果最终纳入24项研究,共计2 020例患者。Meta分析结果显示两组食管静脉曲张根除率差异无统计学意义相对危险度(RR)=1.04,95%CI(0.99,1.09),P=0.090],EVL组较EVS组更能减少食管静脉曲张再出血率RR=0.69,95%CI(0.59,0.81),P=0.000]、病死率RR=0.76,95%CI(0.63,0.90),P=0.002]和并发症发生率RR=0.41,95%CI(0.26,0.63),P=0.000],且差异具有统计学意义,但是在减少食管静脉曲张复发率方面,EVS组有更好的优越性,差异具有统计学意义RR=1.67,95%CI(1.40,2.01),P=0.000]。结论现有证据表明,与内镜下EVS比较,EVL治疗食管静脉曲张破裂出血的静脉曲张根除率与EVS法相当,但EVL法的食管静脉曲张再出血率、病死率及并发症发生率更小。

Endoscopic variceal ligation versus endoscopic variceal sclerotherapy in treatment of esophageal variceal bleeding: a meta-analysis

Objective?To make a systematical review of the efficacy and safety of endoscopic variceal ligation versus endoscopic variceal sclerotherapy for treatment of esophageal variceal bleeding.?Methods?We electronically searched databases including PubMed, Web of Science, The Cochrane Library (Issue 2, 2016), CNKI, WanFang Data and from Jan., 1980, to Mar., 2015, collected randomized controlled trials (RCTs) about EVL versus EVS for the patients of esophageal variceal bleeding. Then, meta-analysis was performed using RevMan 5.3 software.?Results?A total of 24 studies including 2020 patients were included. The results of meta-analysis showed that, there were no significant differences in the variceal eradication rate (RR = 1.04, 95%CI 0.99 to 1.09, P = 0.090) between the EVL group and the EVS group; Compared with the EVS group, the EVL group could significantly reduce the rate of variceal rebleeding (RR = 0.69, 95%CI 0.59 to 0.81, P = 0.000), the rate of mortality (RR = 0.76, 95%CI 0.63 to 0.90, P = 0.002) and the rate of complication (RR = 0.41, 95%CI 0.26 to 0.63, P = 0.000), but the rate of variceal recurrent rate of EVS group was lower than that of the EVL group (RR = 1.67, 95%CI 1.40 to 2.01, P = 0.000).?Conclusion?Current evidence shows that, the variceal eradication rate between EVL and EVS is similar, but the EVL has less incidence of variceal rebleeding and mortality and complication.