ERCP胆道内支架与骑跨十二指肠乳头支架置入治疗不可切除肝门部胆管癌疗效的Meta分析  

Meta-analysis of efficacy of ERCP with biliary stent and stent implantation across duodenal papilla for unresectable hilar cholangiocarcinoma

作　　者：马振威 宋润夫 王兵[1] Ma Zhenwei;Song Runfu;Wang Bing(Department of Biliary and Pancreatic Surgery,Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院胆胰外科,武汉430030

出　　处：《中华肝脏外科手术学电子杂志》2024年第6期807-812,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金(81502108)

摘　　要：目的比较ERCP胆道内支架和骑跨十二指肠乳头支架置入治疗不可切除肝门部胆管癌的安全性及有效性。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(CBM)、中国知网(CNKI)、维普(VIP)、万方数据库,以获取ERCP胆道内支架与骑跨十二指肠乳头支架治疗不可切除肝门部胆管癌的文献。检索时间为2003年1月至2023年6月。采用纽卡斯尔-渥太华量表(NOS)评分评估纳入文献的质量,RevMan 5.4软件进行Meta分析。结果本Meta分析最终纳入5篇文献,结果显示胆道内支架置入术后支架通畅时间≥3个月患者的畅通率明显高于骑跨十二指肠乳头支架置入患者(OR=4.18,95%CI:1.81~9.68,P<0.001);而术后胰腺炎的发生率明显低于骑跨十二指肠乳头支架置入患者(RR=0.18,95%CI:0.03~0.93,P=0.04)。两组术后胆管炎发生率(RR=0.79,95%CI:0.41~1.52,P=0.47)、术后支架闭塞发生率(RR=1.06,95%CI:0.83~1.34,P=0.65)、术后支架移位发生率(RR=0.52,95%CI:0.20~1.36,P=0.18)、术后出血发生率(RR=0.96,95%CI:0.21~4.27,P=0.95)差异均无统计学意义。结论对于不可切除的肝门部胆管癌患者,与骑跨十二指肠乳头支架置入相比,ERCP胆道内支架置入不但术后胆道支架通畅时间更久,而且胰腺炎发生率更低,其为临床治疗提供新思路。Objective To compare the safety and efficacy of ERCP with biliary stent and stent implantation across the duodenal papilla in the treatment of unresectable hilar cholangiocarcinoma.Methods Relevant studies of ERCP with biliary stent and stent implantation across the duodenal papilla in the treatment of unresectable hilar cholangiocarcinoma were searched from PubMed,Embase,Web of Science,Cochrane Library,China Biomedical Literature Database(CBM),CNKI,Chongqing VIP and Wanfang Data from January 2003 to June 2023.Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of the included studies,and RevMan 5.4 software was used for Meta-analysis.Results Five studies were included in this Meta-analysis.The results showed that the patency rate of patients with stent patency time≥3 months after biliary stent implantation was significantly higher than that of those treated with stent implantation across the duodenal papilla(OR=4.18,95%CI:1.81-9.68,P<0.001).The incidence of postoperative pancreatitis was significantly lower than that of their counterparts with stent implantation across the duodenal papilla(RR=0.18,95%CI:0.03-0.93,P=0.04).There was no statistical significance in the incidence rates of postoperative cholangitis(RR=0.79,95%CI:0.41-1.52,P=0.47),postoperative stent occlusion(RR=1.06,95%CI:0.83-1.34,P=0.65),postoperative stent displacement(RR=0.52,95%CI:0.20-1.36,P=0.18),postoperative bleeding(RR=0.96,95%CI:0.21-4.27,P=0.95)between two groups.Conclusions For patients with unresectable hilar cholangiocarcinoma,ERCP with biliary stent implantation not only yields longer postoperative patency time,but also has a lower incidence of postoperative pancreatitis compared with stent implantation across the duodenal papilla,which provides a novel idea for clinical treatment.

关 键 词：肝门部胆管癌 胆道内支架 十二指肠乳头支架 META分析 

分 类 号：R735.7[医药卫生—肿瘤]