不同术前胆道引流方式对可切除性恶性梗阻性黄疸种植性转移发生率的影响:Meta分析  

Effects of different preoperative biliary drainage on seeding metastasis incidence for resectable malignant obstruction jaundice : A Meta analysis

作　　者：王垒 林南平 柯桥 刘志强 曾永毅 刘景丰 WANG Lei;LIN Nan-ping;KE Qiao;LIU Zhi-qiang;ZENG Yong-yi;LIU Jing-feng(The Joint Innovation Key Laboratory of Mengchao Hepatobiliary Technology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China)

机构地区：[1]福建医科大学孟超肝胆医院孟超肝胆技术联合创新重点实验室,福建福州350025

出　　处：《肝胆胰外科杂志》2019年第2期91-97,共7页Journal of Hepatopancreatobiliary Surgery

基　　金：吴阶平医学基金会项目(LDWJPMF-102-17007)

摘　　要：目的系统评价不同术前胆道引流方式对可切除性恶性梗阻性黄疸(malignant obstructive jaundice,MOJ)种植性转移发生率的影响。方法计算机检索PubMed、EMbase、Web of Science、Cochrane Library、中国生物医学文献数据库、中国知网、万方及维普数据库,纳入比较可切除性MOJ经皮肝胆道引流(percutaneous transhepatic biliary drainage,PTBD)和经内镜胆道引流(endoscopic biliary drainage,EBD)的种植性转移率的临床对照研究。检索时限均从建库至2017年10月。应用比值比(odds,OR)和95%可信区间(confidence,CI)评价结局指标。用Review Manager 5.3软件进行Meta分析。结果共纳入10项研究,其中PTBD组1 085例、EBD组1 379例。分析结果表明,两种术前胆道引流方式的种植性转移率显著不同(OR 4.91,95%CI 0.23～0.53,P<0.00001)。亚组分析发现,在腹膜种植性转移和导管种植性转移上,EBD组均明显少于PTBD组(OR 3.34,95%CI 0.31～0.74,P=0.0008;OR 4.47,95%CI 0.12～0.44,P<0.00001);并且,这一优势在肝门部胆管癌、远端胆管癌和胰腺癌同时得到验证(OR 2.76,95%CI0.17～0.74,P=0.006;OR 3.50,95%CI 0.17～0.60,P=0.0005;OR 6.62,95%CI 0.19～0.40,P<0.00001)。结论本Meta分析显示,在可切除性MOJ的术前胆道引流的选择上,经内镜胆道引流后种植性转移发生率更低,但目前尚缺乏充足的循证医学证据支持。Objective To compare the effects of percutaneous transhepatic biliary drainage (PTBD) and endoscopic biliary drainage (EBD) on seeding metastasis incidence for resectable malignant obstruction jaundice (MOJ). Methods Databases including PubMed, EMbase, Web of Science, Cochrane Library, sinoMed, CNKI, Wanfang Database and VIP Database. Literature was searched up to Oct. 2017 for controlled clinical trials, which were designed to compare the effects of PTBD and EBD on seeding metastasis incidence between for MOJ. Odds Ratio ( OR ) with 95% confidence interval ( CI ) was performed with Review Manager 5.3 software. Results A total of 10 studies were enrolled in this meta-analysis, including 1 085 cases in the PTBD group and 1 379 cases in the EBD group. It was showed that there were significant incidence differences of seeding metastasis between PTBD group and EBD group ( OR 4.91, 95% CI 0.23~0.53, P <0.00001). Subgroup analysis showed that both the incidences of peritoneal metastasis and tube-related seeding metastasis were lower in the EBD group ( OR 3.34, 95% CI 0.31~0.74, P =0.0008; OR 4.47, 95% CI 0.12~0.44, P <0.00001, respectively), and the advantage of EBD was demonstrated in perihilar cholangiocarcinoma, distal cholangiocarcinoma and pancreatic cancer ( OR 2.76, 95% CI 0.17~0.74, P =0.006; OR 3.50, 95% CI 0.17~0.60, P =0.0005; OR 6.62, 95% CI 0.19~0.40, P <0.00001 respectively). Conclusion This Meta analysis shows that the choice of preoperative biliary drainage for resectable malignant obstruction jaundice, endoscopic biliary drainage has lower seeding metastasis incidence, although there is currently not enough evidence.

关 键 词：恶性梗阻性黄疸 术前胆道引流 经皮肝胆道引流 经内镜胆道引流 种植性转移 

分 类 号：R657.4[医药卫生—外科学]