Efficacy of Partial Splenic Artery Embolization Versus Splenectomy for Hypersplenism Secondary to Liver Cirrhosis:a Meta-analysis
10.11969/j.issn.1673-548X.2024.01.017
- VernacularTitle:部分脾动脉栓塞术对比脾切除术治疗肝硬化脾功能亢进的Meta分析
- Author:
Zhiqiang ZHANG
1
;
Ying PU
;
Wei CHEN
Author Information
1. 441000 湖北医药学院附属襄阳市第一人民医院消化内科
- Keywords:
Partial splenic artery embolization;
Splenectomy;
Liver cirrhosis;
Hypersplenism;
Meta-analysis
- From:
Journal of Medical Research
2024;53(1):80-87,97
- CountryChina
- Language:Chinese
-
Abstract:
Objective To systematically evaluate the efficacy of partial splenic artery embolization(PSE)and splenectomy in the treatment of secondary hypersplenism in liver cirrhosis.Methods PubMed,Cochrane Library,Embase,CNKI,Wan Fang were searched to collect randomized controlled trials and cohort studies about the efficacy of PSE versus splenectomy in the treatment of hyper-splenism secondary to liver cirrhosis from inception to October 30,2021.Two reviewers screened the literature,extracted data,and as-sessed the risk of bias of included studies.Meta-analysis was then conducted.Results A total of 14studies were included with 1092 patients.The results of the meta-analysis showed that there was no significant difference in postoperative leukocyte levels at 1 week,1 month,and 1 year after surgery between the PSE group and the splenectomy group.However,6months after surgery,the level of postop-erative leukocyte in the splenectomy group was significantly higher than that in the PSE group.For postoperative platelet counts,there was no significant difference at 1 month and 1 year after surgery between the two groups.However,1 week(MD=-65.46,95％CI:-116.39--14.52,P=0.01)and 6months(MD=-117.99,95％CI:-229.71--6.27,P=0.04)after surgery,the level of postoperative platelet in splenectomy group was significantly higher than that in PSE group.There was no significant difference in postoperative erythro-cyte levels at 1 week,1 month,and 1 year after surgery between the two groups.The level of postoperative natural killer cells in the PSE group was significantly higher than that in the splenectomy group at 1 month(MD=6.02,95％CI:4.27-7.77,P＜0.001)and 1 year(MD=3.53,95％CI:1.68-5.37,P=0.0002)after surgery.Compared with splenectomy group,PSE group exhibited less intraopera-tive bleeding(MD=-73.92,95％CI:-89.39--58.45,P＜0.001),less hospitalization costs(MD=-0.80,95％CI:-1.27--0.34,P=0.0008)and shorter length of stay(MD=-4.08,95％CI:-5.22--2.95,P＜0.001).Conclusion The current evi-dence shows that PSE has certain short-term and long-term effects on hypersplenism.Compared with splenectomy,it has less surgical trauma,less hospital stay and less cost,easy to control complications,and retains some immune function,which is worth spreading in the clinic.Limited by the quantity and quality of the included literature,more high-quality studies are needed to confirm the above conclu-sions.
