PDF下载 ( 2745 KB)
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。
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。 -
关键词:
- 黄疸, 梗阻性 /
- 引流术 /
- 支架 /
- Meta分析(主题)
Abstract:Objective To investigate the clinical effect and safety of endoscopic nasobiliary drainage (ENBD) versus endoscopic biliary stenting (EBS) in preoperative biliary drainage for low-level malignant obstructive jaundice. Methods Chinese and English databases were searched for control studies on the clinical effect of ENBD versus EBS in preoperative biliary drainage for low-level malignant obstructive jaundice published up to August 2020. After quality assessment and data extraction were performed for the studies included, RevMan 5.3 software was used to perform the meta-analysis. ENBD and EBS were compared in terms of incidence rates of preoperative cholangitis and preoperative pancreatitis, stent dysfunction rate, overall incidence rate of complications before and after surgery, and rate of postoperative pancreatic leakage. Results Six studies involving 1182 patients were included. The meta-analysis showed that there were no significant differences between the ENBD group and the EBS group in incidence rate of preoperative pancreatitis (odds ratio [OR]=0.66, 95% confidence interval [CI]: 0.44-0.99, P=0.05), stent dysfunction rate (OR=1.14, 95% CI: 0.56-2.31, P=0.72), and overall incidence rate of complications before and after surgery (OR=0.69, 95% CI: 0.41-1.15, P=0.15). Compared with the EBS group, the ENBD group had significant reductions in incidence rate of preoperative cholangitis (OR=0.34, 95% CI: 0.23-0.50, P < 0.000 01) and rate of postoperative pancreatic leakage (OR=0.53, 95% CI: 0.32-0.88, P=0.01). Conclusion Preoperative biliary drainage with ENBD is superior to EBS in patients with well-diagnosed low-level malignant obstructive jaundice. More large multicenter randomized controlled trials are needed in the future to verify this conclusion. -
Key words:
- Jaundice, Obstructive /
- Drainage /
- Stents /
- Meta-Analysis as Topic
-
[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. 期刊类型引用(17)
1. 杨文帅，王立坤，董聪慧，武永萍，石栓柱. 瞬时弹性成像技术联合血清游离脂肪酸对非酒精性脂肪性肝病的诊断价值. 转化医学杂志. 2024(09): 1330-1335 . 
百度学术2. 崔会鹏，田昊宇，关琳，李异玲. 代谢相关性脂肪性肝病无创诊断方法研究进展. 胃肠病学和肝病学杂志. 2022(01): 99-103 . 百度学术3. 凡军芳，胡静，耿旭，庄兰艮，时照明. 2型糖尿病患者肝脏受控衰减参数与血清25-羟维生素D的相关性. 中华全科医学. 2021(05): 794-797 . 百度学术4. 陈雅洁，李昭贤，王洋，曹经琳，窦剑. 瞬时弹性成像技术在肝移植围手术期应用的研究进展. 中华器官移植杂志. 2021(08): 501-504 . 百度学术5. 林俊红，林常青，翁娜，刘宴伟. 中年女性高血压体检者体质指数异常与脂肪肝发病率的相关性研究及护理干预. 全科护理. 2020(10): 1212-1214 . 百度学术6. 张晓静，林淑珍，张志安，温美兰. FibroTouch技术在诊断非酒精性脂肪性肝病患者肝脂肪变程度中的应用. 临床医学. 2020(04): 79-80 . 百度学术7. 李萍英，李娟，谢守珍，杨永耿，陆伦根. FibroTouch联合超声和CT检查诊断高原地区非酒精性脂肪性肝病临床应用研究. 实用肝脏病杂志. 2020(06): 817-820 . 百度学术8. 李正鑫，陈洋溢，赵志敏，吕靖，陈高峰，刘成海. 基于肝脏病理学对慢性乙型肝炎肝硬化患者FibroTouch测量值的影响因素分析. 临床肝胆病杂志. 2019(02): 338-344 . 
本站查看9. 陈中淑. 超声检查在诊断脂肪肝方面的临床应用价值. 当代医药论丛. 2019(10): 26-28 . 百度学术10. 何义华，罗建君，文安怡，程志生，余志映，吴舒婷. 二至解酲汤治疗酒精性肝病临床研究. 中医学报. 2018(06): 1099-1102 . 百度学术11. 何妙峰. 腹部B超对健康体检者脂肪肝筛查的价值分析. 深圳中西医结合杂志. 2018(10): 90-91 . 百度学术12. 王晴晴，胡明芬，杨红洁，禹蔚琴，柏保利，匡小林，庄林. B超在慢性HBV携带者合并非酒精性脂肪性肝病诊断中的应用. 肝脏. 2018(08): 723-727 . 百度学术13. 王新. 脂肪肝与病毒性肝炎B超鉴别诊断结果的对比研究. 心理月刊. 2018(04): 47-48 . 百度学术14. 张志伟. 肝功能与血清学指标水平检验对脂肪肝的诊断价值分析. 中外医疗. 2018(34): 11-13 . 百度学术15. 南胜天. CT及B超在脂肪肝临床诊断中应用的价值. 甘肃科技. 2017(07): 102-103 . 百度学术16. 庄小芳，孙洁，王晓波，王燕，吴琦琦，王晓忠. 瞬时弹性成像技术诊断非酒精性脂肪性肝病的性能评估. 临床肝胆病杂志. 2017(12): 2366-2371 . 本站查看17. 杨杰，曹玉芝，徐永升，王雪，刘闯. 373例非酒精性脂肪性肝病FibroTouch检测临床观察. 中国实用医药. 2017(24): 33-34 . 百度学术其他类型引用(12)
-
下载:
百度学术
