| Objective:Using meta-analysis to explore transjugular intratrahepatic Portosystemic shunt(TIPS)to puncture different portal vein branches(left or right)to establish a shunt path,exploring the differences in the effects on hepatic encephalopathy,rebleeding,and shunt stenosis.Methods: Performing a pre-search on related topics,and formulating a reasonable search term according to the pre-search situation,after confirming the direction.Key words were determined using the MESH medical topic vocabulary to obtain comprehensive literature by expanding the search scope.Pub Med,Embase database,Cochrane Library,Web of Science database,CNKI digital library and Wanfang database should be searched,and manually search through all potential eligible studies to find possible related publications.According to the type of study,research objects,intervention measures,outcome indicators,etc.,formulate the inclusion and exclusion criteria,and strictly include the randomized controlled trials and cohort studies that meet the requirements in accordance with the inclusion and exclusion conditions.Using different literature quality evaluation tools to evaluate the quality of the literature,then extract relevant data from the literature,and using Stata15.0 software for statistical analysis.Result:Use the following terms in Pub Med,Cochrane,Embase,Web of science databases:”Liver fibrosis”、”Portal Hypertension”、”transjugular intrahepatic portosystemic”、”Portal vein”,Use the following search terms in CNKI Electronic Library and Wanfang Database: "Cirrhosis","fibrosis","liver disease","portal hypertension","portal hypertension","portal hypertension","portal hypertension","portal hypertension","TIPS","TIPSS","Transjugular intrahepatic portosystemic shunt","Portal branch","Portal system","Portal vein",a total of 1083 documents retrieved.After importing retrieved documents into document management software for deduplication,make a preliminary selection based on information that can be read initially(such as the document title),then download the document and read the full text,and finally rescreen the articles based on inclusion and exclusion criteria.One randomized controlled trial and eight cohort studies were obtained,for a total of 2052 CPH patients receiving TIPS.During TIPS,there were 1,425 patients who punctured the left branch of the portal vein and 627 patients who punctured the right branch of the portal vein.A total of 9 literatures with a outcome index of hepatic encephalopathy were included.using STATA15.0 software to test the heterogeneity of the literature χ~2=6.46,p =0.596,I~2=0%.It can be considered that the included literature has better homogeneity.However,due to the characteristics of the research subjects used in the original literature,the details of study types and interventions(stent type,stent diameter,follow-up time,etc.)are not exactly the same.Similarly,the random effects model is still used for meta-analysis.The results showed that: RR = 0.551,95% CI: 0.450 ～ 0.680,P <0.05,which was statistically significant.A total of 5 literatures with a outcome index of hepatic encephalopathy were included.using STATA15.0 software to test the heterogeneity of the literature χ~2=0.91,p=0.923,I~2=0%.It can be considered that the included literature has better homogeneity.However,due to the characteristics of the research subjects used in the original literature,the details of study types and interventions(stent type,stent diameter,follow-up time,etc.)are not exactly the same.Similarly,the random effects model is still used for meta-analysis.The results showed that:RR=0.800,95%CI:0.615～1.041,P=0.096,which was no statistically significant.A total of 5 literatures with a outcome index of hepatic encephalopathy were included.using STATA15.0 software to test the heterogeneity of the literature χ~2=0.91,p=0.923,I~2=0%.It can be considered that the included literature has better homogeneity.However,due to the characteristics of the research subjects used in the original literature,the details of study types and interventions(stent type,stent diameter,follow-up time,etc.)are not exactly the same.Similarly,the random effects model is still used for meta-analysis.The results showed that:RR=0.800,95%CI:0.615～1.041,P=0.096,which was no statistically significant.A total of 5 literatures with a outcome index of hepatic encephalopathy were included.using STATA15.0 software to test the heterogeneity of the literature χ~2=5.00,p=0.287,I~2=20.1%,Considering heterogeneity among the included studies to be acceptable.However,due to the characteristics of the research subjects used in the original literature,the details of study types and interventions(stent type,stent diameter,follow-up time,etc.)are not exactly the same.Similarly,the random effects model is still used for meta-analysis.The results showed that:RR=0.474,95%CI:0.287～0.783,P=0.004,which wasstatistically significant.Divided into two subgroups according to the type of stent used in TIPS(naked stent or covered stent).The literature using bare stents is a subgroup,and the literature using covered stents is another subgroup.STATA15.0 software was used to test the heterogeneity of the literatures included in the two subgroups,The results showed that:χ~2=4.90,p=0.179,I~2=38.8%,Heterogeneity between the two included literatures was considered acceptable.Trial subgroup using bare stents during TIPS RR=1.00,95%CI:0.438～2.281,p>0.05,which was no statistically significant.Subgroup of trials using covered stents during TIPS RR=0.332,95%CI:0.177～0.622,p=0.001,which was statistically significant.Meta-analysis of the included literature as a whole,The results showed that:RR=0.462,95%CI:0.238～0.894,p=0.022,which was statistically significant.Conclusion:1、It is recommended to use the left branch of the portal vein as a shunt during TIPS to reduce the incidence of hepatic encephalopathy in patients with CPH.2、In terms of rebleeding rate in patients with CPH,the effect of choosing the left branch of the portal vein is similar to that of the right branch of the portal vein during TIPS.3、In terms of rebleeding rate in patients with CPH,the effect of choosing the left branch of the portal vein is similar to that of the right branch of the portal vein during TIPS.4、It is recommended to use the left branch of the portal vein as a shunt during TIPS to reduce the incidence of shunt stenosis in patients with CPH after surgery.Subgroup analysis showed that in the process of selecting the left branch of the portal vein as the shunt path during TIPS surgery,the use of covered stents can reduce the narrowing rate of the shunt stent compared with bare stents. |
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