A Meta Analysis Of Efficacy And Factors Influencing The Efficacy Of Transjugular Intrahepatic Portosystemic Shunt In The Treatment Of Refractory Ascites Due To Cirrhosis

Complications caused by decompensation in patients with liver cirrhosis are the main reason for the reduced survival rate of patients,and stubborn ascites is one of the most terrible complications of liver cirrhosis.The occurrence of obstinate ascites can significantly reduce the survival rate of patients to 50%.Transjugular intrahepatic portosystemic shunt can improve refractory ascites in patients with liver cirrhosis,but most of the current studies are small sample studies that cannot comprehensively judge the efficacy of this treatment method on patients.In this study,meta-analysis was used to comprehensively evaluate the efficacy of intrahepatic portal-systemic shunt via jugular vein in the treatment of refractory ascites due to cirrhosis;At the same time,analyze the factors that affect the survival rate of patients after transjugular intrahepatic portosystemic shunt,formulate more accurate surgical indications and improve the curative effect of patients through the effective intervention of these factors.Methods:According to the inclusion and exclusion criteria,the database has been searched and published in Pub Med,EMBASE,Web of Science,the Cochrane Library,and other databases.For the case-control study or cohort study of the risk factors of post-survival rate,R4.1.1 software was used for Meta-analysis.Results:1.Efficacy analysis of transjugular intrahepatic portosystemic shunt in the treatment of refractory ascites due to cirrhosis1)A total of 417 articles were retrieved in this study.47 papers were excluded from duplicates,21 papers were excluded from conference papers and reviews,75 papers were excluded from Chinese articles,75 papers were excluded from irrelevance,and 101 papers were excluded from data integrity and data extraction.Finally,a total of 37 papers were included.A total of 4055 patients were from Sweden,Germany,Italy,France,China,India,the United States,Spain,Australia,South Korea and Japan,of which 2812 were effective.The results showed that the effective rate of transjugular intrahepatic portosystemic shunt in the treatment of refractory ascites in patients with liver cirrhosis was 0.69(95%CI: 0.64,0.75).There is publication bias in the study,but the results are stable and reliable.2)Subgroup analysis showed that the effective rates of TIPS in the treatment of refractory ascites in patients with liver cirrhosis were: Sweden 0.72(95%CI: 0.49,1.00);Germany: 0.68%(95%CI: 0.55,0.84);Italy For: 0.63(95%CI: 0.54,0.75);China: 0.75(95%CI: 0.69,0.80);Germany: 0.68(95%CI: 0.55,0.84);United States:0.77(95%CI: 0.84)0.64,0.92);France: 0.59(95%CI: 0.48,0.72),Australia: 0.96(95%CI: 0.80,1.00);India 0.74(95%CI: 0.67,0.81);Spain 0.51(95 %CI: 0.43,0.59);Korea 0.71(95%CI: 0.61,0.81);Canada 0.71(95%CI: 0.53,0.95)and Japan 0.79(95%CI: 0.64,0.97).2.Analysis of factors influencing the efficacy of transjugular intrahepatic portosystemic shunt in the treatment of refractory ascites due to cirrhosis1)A total of 13 articles were included.The factors affecting the survival of patients mainly include: age,gender,systolic blood pressure,creatinine,platelets,hepatorenal syndrome,end-stage liver disease score,platelet ratio index,fibro-4index,bilirubin,albumin,sodium content,insulin resistance,diabetes,neutrophil to lymphocyte ratio,hepatitis Bvirus,hepatic encephalopathy,body mass index,Results of nonalcoholic fatty liver and polysomnography before and after operation.2)The HR value of the influence of age on the survival of patients after TIPS was 1.03(95% CI: 1.01,1.04);The HR value of the effect of creatinine on the survival of patients after TIPS was 1.23(95% CI: 1.01,1.49);The HR value of the influence of platelets on the survival of patients after TIPS was 1.00(95% CI: 0.99,1.00);The HR value of the impact of end-stage liver disease score on the survival of patients after TIPS was 1.08(95% CI: 1.05,1.11);The HR value of the effect of bilirubin on the survival of patients after TIPS was 0.90(95% CI: 0.70,1.14);The HR value of the influence of hepatitis Bvirus on the survival of patients after TIPS was0.89(95% CI: 0.64,1.23).Conclusion:The results of this study show that TIPS has a good effect in the treatment of patients with refractory ascites due to cirrhosis.The main factors affecting the postoperative mortality of patients include age,creatinine and MELD score.