Meta-analysis Of Progress In Medical Drug-assisted Treatment And Surgical Treatment Of Liver Cirrhosis And Portal Hypertension

Objective To systematically evaluate the effect of carvedilol vs.propranolol liver cirrhosis on reducing portal pressure in patients with portal hypertension and provide clinical experience and data reference for related clinical work;The feasibility of high blood pressure,detailed analysis of its advantages and disadvantages compared to the traditional open surgery treatment methods,for future clinical treatment of portal hypertension surgery direction,provide relevant reference data.Materials and Methods Use the network to search the Chinese database Vipu and Wanfang database and English database PubMed and Cochrane Library.Internal medicine section: Search keywords in English and Chinese((("Carvedilol" and"Propranolol")and "cirrhosis" and "Portal hypertension"),English database Key words:(((carvedilol "and propranolol)and cirrhosis)and "portal hypertension"),type of clinical research,language and publication date are not specified,read through the abstract of the first search out of the clinical study,such as the abstract browse to determine the clinical study for the treatment of liver cirrhosis In the context of hypertension,clinical studies comparing the therapeutic effects of carvedilol and propranolol can be incorporated into the full-text reading and evaluation of the next step;surgical part: Key words:((("Laparoscope" and "Open the abdomen" and"splenectomy")and "Cardiac vascular dissection",English database Key words:(((Laparoscopic and open)and splenectomy)and "azygoportal disconnection"),clinical research on the initial search The summary was read through,such as a summary review to determine the clinical study to compare laparoscopic splenectomy with cardiac transection and conventional open splenectomy combined with cardiactransection Clinical study treatment of liver cirrhosis and portal hypertension,can be incorporated into the text read and evaluate its next step.The results were evaluated using the Cochrane risk assessment table and meta-analyses were performed on literature that met the quality criteria.Results In the Department of Internal Medicine,Carvedilol was compared with propranolol mainly through 4 hepatic hemodynamic indexes: In the immediate treatment effect,the rate of decline of HVPG in the carvedilol group was higher than that of propranolol group,and there were differences.Statistically significant,in the long-term follow-up treatment effect,the rate of decline in HVPG in the carvedilol group was higher than that in the propranolol group,and the difference was statistically significant;the number of non-responders to immediate and long-term follow-up in the carvedilol group was higher than that of propranolol There were fewer lobar groups;the rate of decline in MAP was higher in the carvedilol group than in the propranolol group;the level of WHVP was lower in the carvedilol group after immediate and long-term treatment than in the propranolol group.8retrospective studies have concluded that laparoscopy is superior to traditional open surgery in the treatment of liver cirrhosis and portal hypertension(8 studies were retrospective,overall quality is low,meta analysis shows heterogeneity Higher,funnel analysis chart suggests higher publication bias riskConclusion Carvedilol is more effective in reducing HPVG than propranolol,and there is less HVPG non-response than propranolol in patients taking carvedilol,revealing that carvedilol is used in adjuvant surgery for cirrhosis.Potential advantages in portal hypertension;The advantages of laparoscopic splenectomy and cardiotomy need further clinical randomized prospective studies,more advanced solid clinical evidence to reveal,and now fully replace the traditional open surgery It is too early to say that more experience and high-quality randomized prospective clinical studies are still needed to reveal its advantages.Although liver transplantation can achieve the therapeutic effect of curing cirrhosis and portal hypertension,it is subject to various conditions and is still in the preliminary stage.In the future hepatobiliary surgery,minimally invasive laparoscopic surgical treatment of cirrhosis of portal hypertension will become the mainstream surgery.