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

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

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<0.00001、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。

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<0.00001)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.