抗反流支架与常规支架治疗远端食管贲门处狭窄的系统评价  

Antireflux stents versus conventional stents for management of stenosis of distal esophageal and gastric cardia:An systematic review

作　　者：胡学军[1] 张虎 邵国安[1] 王尚前[1] 刘贵峰[1] 徐永耀[1] 陆红[2] 

机构地区：[1]新疆医科大学第五附属医院肿瘤中心,新疆维吾尔自治区乌鲁木齐市830011 [2]新疆医科大学第五附属医院门诊部,新疆维吾尔自治区乌鲁木齐市830011

出　　处：《世界华人消化杂志》2012年第24期2270-2275,共6页World Chinese Journal of Digestology

摘　　要：目的:评价置入抗反流支架和常规支架治疗食管癌远端食管贲门处狭窄患者的疗效及安全性.方法:计算机检索PubMed(1978-2011)、EMbase(1966-2011)、CBM(1978-2011)、Cochrane Library(2011年第10期)和CNKI(1979-2011)并手工检索中、英文已发表的资料和会议论文并追索纳入文献的参考文献,查找比较置入抗反流支架和普通支架治疗食管癌远端食管贲门处狭窄患者的随机对照试验(randomized controlled trials,RCTs).对纳入研究进行方法学质量评价之后,采用Rev Man5.1软件进行Meta分析.结果:共纳入5个RCTs,合计234例患者.Meta分析结果表明:抗反流支架与置入常规支架相比,术后患者出现疼痛(RR=0.41,95%CI:0.16,1.06),支架移位(RR=1.02,95%CI:0.50,2.11),梗阻(RR=1.02,95%CI:0.52,1.99),胃食管反流(RR=1.68,95%CI:0.52,5.48),出血(RR=1.39,95%CI:0.44,4.40),食管胃穿孔(RR=0.70,95%CI:0.25,2.00)等方面没有显著性差异.结论:食管癌远端食管贲门处狭窄患者治疗中置入抗反流支架和常规支架的疗效无明显差异.由于纳入研究数量少,加之质量普遍较低,上述结论尚需开展更多设计合理、执行严格的多中心大样本且随访时间足够的RCTs加以验证.AIM： To evaluate the efficacy and safety of anti- reflux stents versus conventional stents for the management of stenosis of distal esophageal and gastric cardia in patients with esophageal cancer.that evaluated anti-reflux stents versus con- ventional stents in the treatment of stenosis of distal esophageal and gastric cardia in patients with esophageal cancer were electronically searched from the PubMed （1978-2011）, EMbase （1966-2011）, CBM （1978-2011）, Cochrane Library （2011, Issue 11） and CNKI （1979-2011） databases, and relevant published and unpublished data and their references （either in English or Chinese）, were also searched manually. The data were ex- tracted and the methodological quality of the in- corporated studies was evaluated by two review- ers independently. The RevMan 5.1 software was used for meta-analysis. RESULTS： Five RCTs involving 234 patients were included. Meta-analysis showed that anti- reflux stents and conventional stents had no sig- nificant differences in terms of the incidences of pain （RR = 0.41, 95% CI： 0.16, 1.06）, stent migra- tion （RR = 1.02, 95% CI： 0.50, 2.11）, obstruction （RR = 1.02, 95 % Ch 0.52, 1.99）, gastroesophageal reflux （RR = 1.68, 95% CI： 0.52, 5.48）, bleeding （RR = 1.39, 95% CI： 0.44, 4.40）, and perforation of the esophagus and stomach （RR = 0.70, 95% CI： 0.25, 2.00）. CONCLUSION： The of anti-reflux stents overall curative efficacy for the stenosis of distal esophageal and gastric cardia in patients with esophageal cancer is not better than that of con- ventional stents. Because of the generally low quality and a small number of studies in the incorporated research, the above conclusion re- mains to be validated by carrying out more ran- domized controlled trials with multiple center samples and enough follow-up time.

关 键 词：远端食管贲门 食管癌 支架 抗反流 随机对照试验 系统评价 Meta分析 

分 类 号：R735.1[医药卫生—肿瘤]