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经内镜鼻胆管引流术与经内镜胆道支架置入术在低位恶性梗阻性黄疸术前胆道引流效果比较的Meta分析

王锦程 余佩和 苏松 李波

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经内镜鼻胆管引流术与经内镜胆道支架置入术在低位恶性梗阻性黄疸术前胆道引流效果比较的Meta分析

DOI: 10.3969/j.issn.1001-5256.2021.04.027
利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明:王锦程负责课题设计,资料分析,撰写论文;余佩和参与收集相关文献,修改论文;李波负责拟定写作思路;苏松负责指导撰写文章并最后定稿。
详细信息
    作者简介:

    王锦程(1994—),男,主要从事肝胆胰脾方面的研究

    通信作者:

    苏松,13882778554@163.com

  • 中图分类号: R657.43

Clinical effect of endoscopic nasobiliary drainage versus endoscopic biliary stenting in preoperative biliary drainage for low-level malignant obstructive jaundice: A Meta-analysis

  • 摘要:   目的  比较经内镜鼻胆管引流术(ENBD)和经内镜胆道支架置入术(EBS)在低位恶性梗阻性黄疸术前胆道引流中的有效性及安全性。  方法  在中英文数据库中检索从建库至2020年8月发表的有关ENBD与EBS在低位恶性梗阻性黄疸术前胆道引流疗效对照研究的所有中英文文献,对纳入的研究进行质量评价和数据提取后,采用RevMan 5.3软件进行Meta分析,比较ENBD与EBS术前胆管炎发生率、术前胰腺炎发生率、支架障碍率、术前术后总并发症发生率、术后胰漏率的差异。  结果  最终纳入6项研究,包括1182例患者。Meta分析结果显示,在术前胰腺炎发生率、支架障碍率、术前术后总并发症发生率方面,ENBD组与EBS组比较差异均无统计学意义(OR分别为0.66、1.14、0.69,95%CI分别为0.44~0.99、0.56~2.31、0.41~1.15,P值分别为0.05、0.72、0.15)。但是,ENBD组相较于EBS降低了术前胆管炎发生率和术后胰漏率,差异均有统计学意义(OR分别为0.34、0.53,95%CI分别为0.23~0.50、0.32~0.88,P值分别为 < 0.000 01、0.01)。  结论  对于诊断明确的低位恶性胆道梗阻患者,术前胆道引流使用ENBD优于使用EBS。未来需要更多的多中心大样本随机对照试验来验证这一结论。

     

  • 图  1  文献筛选流程图

    图  2  2组术前胆管炎比较的Meta分析

    图  3  2组术前胰腺炎比较的Meta分析

    图  4  2组支架障碍率比较的Meta分析

    图  5  排除异质性来源后2组支架障碍率比较的Meta分析

    图  6  2组术后胰漏率比较的Meta分析

    图  7  2组术前术后总并发症发生率比较的Meta分析

    表  1  纳入文献基本特征及质量评价

    作者 年份 国家 研究类型 样本量 文献质量评分(NOS评分)
    ENBD组(例) EBS组(例)
    Fujii等[11] 2015 日本 PCS 50 72 7
    Huang等[12] 2015 中国 RCS 18 37 7
    Nakai等[13] 2018 日本 RCS 281 76 7
    Sasahira等[14] 2016 日本 RCS 166 253 7
    Sugiyama等[15] 2013 日本 RCS 38 38 6
    Zhang等[16] 2017 中国 RCS 102 51 7
    注:PCS,前瞻性研究;RCS,回顾性研究。
    下载: 导出CSV
  • [1] PU LZ, SINGH R, LOONG CK, et al. Malignant biliary obstruction: Evidence for best practice[J]. Gastroenterol Res Pract, 2016, 2016: 3296801. DOI: 10.1155/2016/3296801.
    [2] CHEN WW, HUANG K, LIU R, et al. Clinical effect of percutaneous transhepatic cholangial drainage combined with biliary stent implantation in treatment of high malignant obstructive jaundice and the influencing factors for prognosis[J]. J Clin Hepatol, 2019, 35(3): 559-564. DOI: 10.3969/j.issn.1001-5256.2019.03.021.

    陈伟伟, 黄坤, 刘锐, 等. 经皮肝穿刺胆管引流术联合胆道支架植入术治疗高位恶性梗阻性黄疸的效果及预后影响因素分析[J]. 临床肝胆病杂志, 2019, 35(3): 559-564. DOI: 10.3969/j.issn.1001-5256.2019.03.021.
    [3] BERGQUIST A, VON SETH E. Epidemiology of cholangiocarcinoma[J]. Best Pract Res Clin Gastroenterol, 2015, 29(2): 221-232. DOI: 10.1016/j.bpg.2015.02.003.
    [4] YOSHIDA Y, AJIKI T, UENO K, et al. Preoperative bile replacement improves immune function for jaundiced patients treated with external biliary drainage[J]. J Gastrointest Surg, 2014, 18(12): 2095-2104. DOI: 10.1007/s11605-014-2674-2.
    [5] GUNDRY SR, STRODEL WE, KNOL JA, et al. Efficacy of preoperative biliary tract decompression in patients with obstructive jaundice[J]. Arch Surg, 1984, 119(6): 703-708. DOI: 10.1001/archsurg.1984.01390180065011.
    [6] COATES JM, BEAL SH, RUSSO JE, et al. Negligible effect of selective preoperative biliary drainage on perioperative resuscitation, morbidity, and mortality in patients undergoing pancreaticoduodenectomy[J]. Arch Surg, 2009, 144(9): 841-847. DOI: 10.1001/archsurg.2009.152.
    [7] ZHAO SW, SHEN ZY, WANG JC, et al. Effect of biliary drainage methods on patients with obstructive jaundice undergoing pancreaticoduodenectomy[J]. J Surg Concepts Pract, 2020, 25(4): 301-305. DOI: 10.16139/j.1007-9610.2020.04.007.

    赵诗葳, 沈子贇, 王建承, 等. 术前胆道引流方式对合并梗阻性黄疸病人胰十二指肠切除术的影响[J]. 外科理论与实践, 2020, 25(4): 301-305. DOI: 10.16139/j.1007-9610.2020.04.007.
    [8] CHOI SH, GWON DI, KO GY, et al. Hepatic arterial injuries in 3110 patients following percutaneous transhepatic biliary drainage[J]. Radiology, 2011, 261(3): 969-975. DOI: 10.1148/radiol.11110254.
    [9] MOHER D, LIBERATI A, TETZLAFF J, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement[J]. PLoS Med, 2009, 6(7): e1000097. DOI: 10.1371/journal.pmed.1000097.
    [10] LUCHINI C, STUBBS B, SOLMI M, et al. Assessing the quality of studies in Meta-analyses: Advantages and limitations of the Newcastle Ottawa Scale[J]. World J Meta-Analysis, 2017, 5(4): 80-84. DOI: 10.13105/wjma.v5.i4.80.
    [11] FUJII T, YAMADA S, SUENAGA M, et al. Preoperative internal biliary drainage increases the risk of bile juice infection and pancreatic fistula after pancreatoduodenectomy: A prospective observational study[J]. Pancreas, 2015, 44(3): 465-470. DOI: 10.1097/MPA.0000000000000265.
    [12] HUANG X, LIANG B, ZHAO XQ, et al. The effects of different preoperative biliary drainage methods on complications following pancreaticoduodenectomy[J]. Medicine (Baltimore), 2015, 94(14): e723. DOI: 10.1097/MD.0000000000000723.
    [13] NAKAI Y, YAMAMOTO R, MATSUYAMA M, et al. Multicenter study of endoscopic preoperative biliary drainage for malignant hilar biliary obstruction: E-POD hilar study[J]. J Gastroenterol Hepatol, 2018, 33(5): 1146-1153. DOI: 10.1111/jgh.14050.
    [14] SASAHIRA N, HAMADA T, TOGAWA O, et al. Multicenter study of endoscopic preoperative biliary drainage for malignant distal biliary obstruction[J]. World J Gastroenterol, 2016, 22(14): 3793-3802. DOI: 10.3748/wjg.v22.i14.3793.
    [15] SUGIYAMA H, TSUYUGUCHI T, SAKAI Y, et al. Preoperative drainage for distal biliary obstruction: Endoscopic stenting or nasobiliary drainage?[J]. Hepatogastroenterology, 2013, 60(122): 231-234. DOI: 10.5754/hge12621.
    [16] ZHANG GQ, LI Y, REN YP, et al. Outcomes of preoperative endoscopic nasobiliary drainage and endoscopic retrograde biliary drainage for malignant distal biliary obstruction prior to pancreaticoduodenectomy[J]. World J Gastroenterol, 2017, 23(29): 5386-5394. DOI: 10.3748/wjg.v23.i29.5386.
    [17] van der GAAG NA, RAUWS EA, van EIJCK CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas[J]. N Engl J Med, 2010, 362(2): 129-137. DOI: 10.1056/NEJMoa0903230.
    [18] SEWNATH ME, KARSTEN TM, PRINS MH, et al. A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice[J]. Ann Surg, 2002, 236(1): 17-27. DOI: 10.1097/00000658-200207000-00005.
    [19] KARNABATIDIS D, SPILIOPOULOS S, KATSAKIORI P, et al. Percutaneous trans-hepatic bilateral biliary stenting in Bismuth Ⅳ malignant obstruction[J]. World J Hepatol, 2013, 5(3): 114-119. DOI: 10.4254/wjh.v5.i3.114.
    [20] BARKAY O, MOSLER P, SCHMITT CM, et al. Effect of endoscopic stenting of malignant bile duct obstruction on quality of life[J]. J Clin Gastroenterol, 2013, 47(6): 526-531. DOI: 10.1097/MCG.0b013e318272440e.
    [21] YAGIOKA H, HIRANO K, ISAYAMA H, et al. Clinical significance of bile cytology via an endoscopic nasobiliary drainage tube for pathological diagnosis of malignant biliary strictures[J]. J Hepatobiliary Pancreat Sci, 2011, 18(2): 211-215. DOI: 10.1007/s00534-010-0333-x.
    [22] HONG SK, JANG JY, KANG MJ, et al. Comparison of clinical outcome and cost-effectiveness after various preoperative biliary drainage methods in periampullary cancer with obstructive jaundice[J]. J Korean Med Sci, 2012, 27(4): 356-362. DOI: 10.3346/jkms.2012.27.4.356.
    [23] CORTES A, SAUVANET A, BERT F, et al. Effect of bile contamination on immediate outcomes after pancreaticoduodenectomy for tumor[J]. J Am Coll Surg, 2006, 202(1): 93-99. DOI: 10.1016/j.jamcollsurg.2005.09.006.
    [24] YU PH, SU S, CHEN S, et al. Clinical effect of pancreaticoduodenectomy with total mesopancreas excision versus traditional pancreaticoduodenecto-my in treatment of pancreatic head carcinoma and periampullary cancer: A meta-analysis[J]. J Clin Hepatol, 2020, 36(8): 1811-1815. DOI: 10.3969/j.issn.1001-5256.2020.08.026.

    余佩和, 苏松, 陈诗, 等. 胰十二指肠联合全系膜切除术与胰十二指肠切除术治疗胰头癌及壶腹周围癌效果比较的Meta分析[J]. 临床肝胆病杂志, 2020, 36(8): 1811-1815. DOI: 10.3969/j.issn.1001-5256.2020.08.026.
    [25] VELANOVICH V, KHEIBEK T, KHAN M. Relationship of postoperative complications from preoperative biliary stents after pancreaticoduodenectomy. A new cohort analysis and meta-analysis of modern studies[J]. JOP, 2009, 10(1): 24-29. http://www.ncbi.nlm.nih.gov/pubmed/19129611
    [26] KAWAI M, TANI M, HIRONO S, et al. Association of preoperative biliary drainage related complications with postoperative complications after pancreaticoduodenectomy[J]. HPB, 2014, 16: 111-112.
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  • 收稿日期:  2020-09-24
  • 录用日期:  2020-10-16
  • 出版日期:  2021-04-20
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