比较全覆盖自膨式金属支架与塑料支架治疗良性胆管狭窄的Meta分析  

Efficacy of fully covered self⁃expanding metal stents versus multiple plastic stents for benign biliary stric⁃tures:a Meta⁃analysis

作　　者：陈轶晖 张小文[1] 胡晟 洪茂林 CHEN Yihui;ZHANG Xiaowen;HU Sheng;HONG Maolin(Department of Hepatopancre⁃atobiliary Surgery,the Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China)

机构地区：[1]昆明医科大学第二附属医院肝胆胰外科,昆明650101

出　　处：《实用医学杂志》2020年第11期1457-1462,共6页The Journal of Practical Medicine

基　　金：国家自然科学基金资助项目(编号:81760430)。

摘　　要：目的比较全覆盖自膨式金属支架(SEMS)与塑料支架(PS)治疗良性胆管狭窄(BBS)的差异。方法计算机检索中文及英文数据库关于SEMS与PS治疗BBS的对照研究,检索最近5年内发表的文献。对纳入的文献进行质量评价后进行数据提取,用SPSS Statistics 17.0和RevMan5.3软件进行数据分析。结果共纳入文献6篇(其中4篇RCT研究,2篇回顾性研究),共纳入患者334例,SEMS组162例,PS组172例。分析结果显示,SEMS组置入的支架数量明显少于PS组(P<0.01);狭窄消除率相似(OR=1.40;95%CI:0.71~2.77,I^2=16%,P=0.33);狭窄复发率相似(OR=1.53;95%CI:0.81~2.89,I^2=44%,P=0.19);SEMS组支架移位率明显高于PS组(OR=1.95;95%CI:1.05~3.63,I^2=21%,P=0.03);包括了胰腺炎和胆管炎的其他不良事件率相似(OR=1.67;95%CI:0.71~3.94,I^2=0%,P=0.24)(OR=0.48;95%CI:0.17~1.35,I^2=0%,P=0.17)。结论 SEMS治疗BBS能在较少的操作及干预下,得到与PS相似的狭窄消除率和狭窄复发率,但支架移位率明显高于PS。SEMS有望成为取代PS的一线治疗方式。Objective To compare the efficacy of fully covered self⁃expanding metal stents(SEMS)with Multiple plastic stents(PS)in the treatment of Benign biliary strictures(BBS).Methods The controlled studies comparing SEMS and PS in treatment of Benign biliary strictures,published from 2014 to 2019,were searched through several national and international databases.After quality evaluation with Jadad or nos,the data of the included studies was extracted.Meta⁃analysis was conducted by using SPSS Statistics 17.0 and RevMan5.3 software.Results A total of 6 studies,containing 4 RCTs and 2 retrospective studies,were finally included,involving 334 patients with 162 cases in SEMS group and 172 cases in PS group.The results of Meta⁃analysis showed that the number of stents implanted in SEMS group was significantly less than that in PS group(P<0.01);no significant differences were observed in stricture resolution rate(OR=1.4095%CI=0.71~2.77,I^2=16%,P=0.33)and stricture recurrence rate(OR=1.5395%CI=0.81~2.89,I^2=44%,P=0.19);the Stent migration rate in SEMS group was significantly higher than that in PS group(OR=1.9595%CI=1.05⁃3.63,I^2=21%,P=0.03);other adverse events,including pancreatitis and cholangitis,have a similar rate(OR=1.6795%CI=0.71~3.94,I^2=0%,P=0.24)(OR=0.4895%CI=0.17~1.35,I^2=0%,P=0.17).Conclusion In the treatment of BBS with SEMS,the stricture resolution rate and stricture recurrence rate are similar to those in PS with less ERCP/ERC operation and intervention,but the stent migration rate is significantly higher than that in PS.SEMS is expected to be a first⁃line treatment for BBS to replace PS.

关 键 词：良性胆管狭窄 全覆盖自膨式金属支架 塑料支架 支架移位 复发 

分 类 号：R657.4[医药卫生—外科学]