Comparison of Effects of Devascularization versus Shunt on Patients with Portal Hypertension: A Meta-Analysis
G-q Zong, Y Fei, R-m LiuGeneral reports, no. 1, 2015
Objective: To systematically evaluate the effectiveness of devascularizationand shunt on patients with portal hypertension.Methods: Relevant studies compared devascularization andshunt for the treatment of portal hypertension were identifiedsearching the PubMed, Embase, Elsevier, CNKI (ChinaNational Knowledge Infrastructure) database and CochraneTrial Register searches until December 2013. Data of interestfor devascularization and shunt including postoperativerecurrent bleeding, postoperative hepatic encephalopathy,ascites, operative mortality rate, and long term survival ratewere subjected to meta-analysis.Results: Eleven studies were included in the study, the results ofthe meta-analysis showed that all eleven clinical studiesdemonstrated a significantly higher postoperative recurrentbleeding rate with devascularization group than with shuntgroup (Odds Ratio =2.14, 95% CI =(1.42, 3.21), P = 0.0003),the rate of hepatic encephalopathy in the devascularizationgroup was significantly lower compared with the shunt group (Odds Ratio =0.56, 95% CI =(0.38, 0.82), P = 0.003); Ourmeta-analysis of three clinical studies revealed that the reductionof ascites in the devascularization group was significantlyless than the shunt groups (Odds Ratio =0.48, 95% CI =(0.26, 0.89), P = 0.02), the operative mortality rate was notsignificantly different between the devascularization groupthan for shunt group (Odds Ratio =1.54, 95% CI = (0.91,2.63), P = 0.11). And the long-term survival rate was notsignificantly different between the devascularization and shuntgroups (Odds=1.13, ratio, 95% CI =(0.64, 1.99), P = 0.68).Conclusions: Devascularization and shunt have differentadvantages and disadvantages respectively which reflected inpostoperative complications and long term survival rate.
