内镜超声检查对比内镜逆行胰胆管造影引导下胆道引流治疗恶性胆道梗阻疗效的Meta分析

A Meta-analysis of endoscopic ultrasonography comparison endoscopic retrograde cholangiopancreatography guided biliary drainage for malignant biliary obstruction

目的评价内镜超声检查(EUS)对比内镜逆行胰胆管造影(ERCP)引导下胆道引流治疗恶性胆道梗阻的有效性和安全性。方法检索了PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、中国知识基础设施工程、维普数据库和万方数据库等,检索时间截至2019年7月。由2名评价员独立提取资料,采用RevMan 5.3软件进行Meta分析。结果共纳入6项研究,515例患者。Meta分析结果显示,EUS组和ERCP组间技术成功率(OR=0.93,95%CI:[0.45,1.91],P=0.85)、临床成功率(OR=1.27,95%CI:[0.44,3.65],P=0.65)、总体并发症发生率(OR=0.88,95%CI:[0.50,1.53],P=0.65)、术后胆管炎发生率(OR=0.70,95%CI:[0.28,1.75],P=0.44)、术后胆漏发生率(OR=3.83,95%CI:[0.98,15.00],P=0.05)和操作时间(MD=0.94,95%CI:[-6.41,8.28],P=0.80)的差异均无统计学意义。与EUS组相比,ERCP组术后胰腺炎发生率(OR=0.16,95%CI:[0.04,0.57],P=0.005)和再干预率(OR=0.33,95%CI:[0.16,0.70],P=0.004)较高,2组间的差异有统计学意义。结论EUS引导下胆道引流是恶性胆道梗阻的一种有效治疗方式。与ERCP组相比,EUS组术后胰腺炎发生率和再干预率较低,而其他方面的疗效与ERCP组相似。

Objective To evaluate the efficacy and safety of endoscopic ultrasonography(EUS)and endoscopic retrograde cholangiopancreatography(ERCP)guided biliary drainage for malignant biliary obstruction.Methods The PubMed,Embase,Cochrane Library,Web of Science,China Biology Medicine Disc,China National Knowledge Infrastructure,Weipu Data and Wanfang Data et al up to July 2019 were searched.The quality of relevant studies and the extracted data were evaluated independently by our two reviewers and the Meta-analysis was performed by RevMan 5.3 software.Results Six studies and 515 patients were included.The result of the Meta-analysis showed that the technical success rate(OR=0.93,95%CI:[0.45,1.91],P=0.85),clinical success rate(OR=1.27,95%CI:[0.44,3.65],P=0.65),overall complication rate(OR=0.88,95%CI:[0.50,1.53],P=0.65),postoperative cholangitis rate(OR=0.70,95%CI:[0.28,1.75],P=0.44),incidence of postoperative bile leakage(OR=3.83,95%CI:[0.98,15.00],P=0.05),and operation time(MD=0.94,95%CI:[-6.41,8.28],P=0.80)were of no significant difference.But,compared with the EUS group,the incidence of postoperative pancreatitis(OR=0.16,95%CI:[0.04,0.57],P=0.005)and the rate of reintervention(OR=0.33,95%CI:[0.16,0.70],P=0.004)were higher in the ERCP group,and there were significant difference between the two groups.Conclusion EUS-guided biliary drainage was an effective method for malignant biliary obstruction.Compared with the ERCP group,the incidence of pancreatitis and reintervention rate were lower in the EUS group,while the other results were similar.