覆膜与裸金属支架治疗恶性大肠梗阻的系统评价

Systematic review of covered and uncovered self-expanding metallic stents in malignant colorectal obstruction

目的比较覆膜支架与裸金属支架治疗恶性大肠梗阻的有效性和安全性。方法检索比较覆膜与裸支架治疗恶性大肠梗阻,进行荟萃分析。结果共纳入6项研究,纳入464例患者,其中246例接受裸支架植入,218例接受覆膜支架植入。与裸支架相比,覆膜支架可显著降低肿瘤内生支架梗阻率(P=0.0004),但覆膜支架晚期移位率显著高于裸支架(P=0.02)。两组支架植入操作成功率、临床有效率、肿瘤外压支架梗阻率、早期支架移位率、穿孔率和总并发症率都无显著性差异。仅纳入高质量研究、大样本研究和使用部分覆膜支架的研究行敏感性分析,结果基本一致。结论与裸支架相比,覆膜支架植入治疗恶性大肠梗阻易发生晚期移位,肿瘤内生致支架梗阻发生较少。

[ Objective ] To compare the efficacy and safety of covered and uncovered self-expanding metallic stents in malignant colorectal obstruction. [ Methods ] The covered and uncovered self-expanding metallic stents in malignant colorectal obstruction were searched for meta-analysis. [ Results ] Six studies met the inclusion criteria and 464 patients were included. 246 patients received uncovered stent insertion and 218 received covered stent in- sertion. Compared with uncovered stent insertion, covered stent insertion could significantly reduced tumor ingrowth rate （P =0.0004）. However, late migration rate of covered stents was significantly higher than that of covered stents （P =0.02）. There was no significant difference in technical success, clinical success, tumor overgrowth, early migration, perforation, and overall complications between the two groups. [ Conclusions ] Compared with uncovered stent inser- tion, covered stent insertion has more late migration and less tumor in growth.