| Objective: Meta-analysis was used to evaluate the efficacy and safety of splenectomy combined with periosporal vascular devascularization(PCDV)(abbreviated devascularization)contrast with shunt combined with devascularization in the treatment of portal hypertension(PHT).Search for better surgical methods for the treatment of portal hypertension in order to provide evidence-based medical evidence for clinical practice.Methods: To search the Chinese databases systematically: CNKI,CBM,Wan Fang Data,VIP and English databases: Pub Med,EMbase,The Cochrane Library to find relevant literature on the efficacy of shunt combined devascularization surgery vs devascularization in the treatment of PHT.The timebond was from the database built to July 2017.We screened and extracted according to the inclusion and exclusion criteria systematically.Finally,Rev Man 5.3 software was used for meta-analysis.The efficacy of the two surgical methods was evaluated according to the rate of the postoperative rebleeding,the incidence of hepatic encephalopathy,survival rate,and portal vein thrombosis(PVT).The publication bias was evaluated using a funnel plot.Descriptive analysis were for documents which were low quality.Results: In this study,a total of 702 Chinese and English articles were obtained through literature search.After screening,14 studies were included and a total of 1551 patients were included.Meta-analysis showed that splenorenal shunt(SRS)combined group and splenocaval shunt(SCS)group were superior to PCDV group in controlling postoperative rebleeding rate(OR=0.33,95%CI: 0.21-0.52,P<0.01),(OR=0.29,95%CI: 0.14-0.60,P<0.01);In controlling the incidence of postoperative hepatic encephalopathy,the SRS combined with PCDV group and SCS combined with PCDV group had the same efficacy as the PCDV group(OR=0.9,95%CI: 0.44-1.87,P=0.78),(OR=0.86,95%CI: 0.34-2.18,P=0.75);After the survival rate(1 year,3 years,and 5 years),the efficacy of SRS combined with PCDV and PCDV groups were similar(OR=1.35,95%CI: 0.27-6.67,P=0.71),(OR=1.75,95%CI:0.75-4.10,P=0.20),(OR=1.26,95%CI: 0.57-2.79,P=0.58);In the control of postoperative PVT rate,SRS combined with PCDV group and SCS combined with PCDV group were lower than the PCDV group(OR=0.22,95%CI: 0.09-0.57,P<0.01),(OR=0.32,95%CI: 0.19-0.55,P<0.01).Mesocaval shunt group was superior to the PCDV group in controlling postoperative rebleeding rate and 3-year survival rate.However,because the literature did not meet the quality requirements,it was not included in the descriptive analysis.The results of the study funnel plot(rebleeding)suggest that there may be publication bias in the study results.Conclusion: 1.splenorenal shunt or splenocaval shunt combined with devascularization can reduce postoperative complications of PHT compared with devascularization,they are worthy of clinical application.2.Improve the liver function of patients with portal hypertension before surgical treatment can reduce postoperative complications and improve long-term survival. |
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