A Meta Analysis Of Laparoscopic Splenectomy In Combination With Endoscopic Variceal Ligation Compared With Pericardial Devascularization In The Treatment For Esophageal Variceal Bleeding

Objective: To systematically review the efficacy of laparoscopic splenectomy(LS) in combination with endoscopic variceal ligation(EVL) compared with pericardial devascularization(PD) in the treatment for esophageal variceal bleeding.Methods: CNKI、 PubMed and Embase were searched from their inception to January 31, 2016 for randomized controlled trials(RCT), comparing the efficacy of laparoscopic splenectomy in combination with endoscopic variceal ligation compared with pericardial devascularization in the treatment for esophageal variceal bleeding. The included studies were analysed through RevMan 5.3 software.Results: Five RCTs involving a total of 333 patients were included, 160 in LS+EVL group and 173 in PD group. The average blood loss、postoperative hospital stay 、 anal exhaust time and complications in LS+EVL group were obviously lower than that in PD group. There was no obvious difference between the two groups in the comparison of operation time and postoperative portal venous blood flow and portal vein maximum flow rate. The remission rate of postoperative esophageal varices and the induction or aggravation of portal hypertensive gastropathy in LS+EVL group were superior to PD group.Conclusion: Compared with PD, LS+EVL is more feasible and safer in the treatment for esophageal variceal bleeding. But the included studies were not enough, more high quality multicenter randomized controlled trials were needed.