内镜下凝血酶注射治疗胃静脉曲张出血：观察性研究和试验数据的系统评价与荟萃分析

摘要(中文译文)

※ 中文译文由 AI 辅助生成,仅供学术参考,请以英文原文为准。

内镜下凝血酶注射（ETI）治疗门静脉高压患者胃静脉曲张（GV）出血的安全性仍需进一步评估。本荟萃分析系统综述了现有关于ETI治疗GV出血疗效和安全性的证据。两名研究者独立筛选并提取了从数据库建立至2025年5月期间发表的所有相关原始文献的数据。采用非随机研究方法学指数工具评估研究质量。使用RevMan 5.3软件进行荟萃分析，并通过偏倚风险图和漏斗图评估偏倚风险。共纳入13项研究，涉及417例患者。荟萃分析显示，初期止血率为93%（95%置信区间[ ]：0.89-0.95），5日再出血率为11%（95% ：0.07-0.17），晚期再出血率为14%（95% ：0.11-0.19），GV完全闭塞率为36%（95% ：0.11-0.73），6周GV相关死亡率为9%（95% ：0.06-0.15）。总体并发症发生率为2.2%（9/417），其中发热和白细胞增多是最常见的事件。在现有研究中，内镜下凝血酶注射治疗GV出血似乎可实现较高的初期止血率且再出血率较低。所报告的并发症发生率较低，尽管各研究对系统性评估的描述并不一致。现有证据提示其具有潜在疗效和可接受的安全性。

Abstract

The safety of endoscopic thrombin injection (ETI) for treating the bleeding of gastric varix (GV) in patients with portal hypertension requires further evaluation. This meta-analysis systematically reviews the available evidence on the efficacy and safety of ETI for GV bleeding. Two researchers independently screened and extracted data from all relevant original articles published from database inception to May 2025. Study quality was assessed using the Methodological Index for Non-Randomized Studies tool. Meta-analysis was performed using RevMan 5.3 software, with risk of bias assessed via risk of bias plots and funnel plots. Thirteen studies involving 417 patients were included. Meta-analysis revealed an initial hemostasis rate of 93% (95% confidence interval []: 0.89-0.95), a 5-day rebleeding rate of 11% (95% : 0.07-0.17), a late rebleeding rate of 14% (95% : 0.11-0.19), a complete GV obliteration rate of 36% (95% : 0.11-0.73), and a 6-week GV-related mortality rate of 9% (95% : 0.06-0.15). The overall complication rate was 2.2% (9/417), with fever and leukocytosis being the most common events. Endoscopic thrombin injection for GV bleeding appears to achieve high initial hemostasis with low rates of rebleeding in the available studies. Reported complication rates were low, though systematic assessment was not consistently described across studies. It is suggested the potential efficacy and an acceptable safety profile within the available evidences.

如何引用