两种微创引流手术治疗恶性肿瘤引起的梗阻性黄疸效果的Meta分析

Meta-analysis of two kinds of minimally invasive drainage operations in the treatment of obstructive jaundice caused by malignant tumors

目的采用循证医学的方法评价经内镜逆行性胰胆管造影术(ERCP)和经皮肝穿刺胆道引流术(PTCD)治疗恶性梗阻性黄疸的临床效果。方法通过计算机检索有关ERCP或PTCD治疗恶性梗阻性黄疸的随机对照试验(RCT),检索时限为从建库起至2020年8月。两名评价者独立评价纳入文献的质量并提取资料,用RevMan 5.3软件进行Meta分析。结果共纳入8篇RCT研究,共736例患者。Meta分析结果显示:对于低位胆道梗阻者,两组手术成功率无显著差异(P=0.70),对于高位胆道梗阻者,ERCP组手术成功率低于PTCD组(P=0.0007),ERCP组总手术成功率低于PTCD组(P=0.008)。ERCP组治疗低位胆道梗阻者的临床疗效优于PTCD组(P=0.0001),而治疗高位胆道梗阻者的临床疗效低于PTCD组(P=0.005),两组总临床疗效无显著差异(P=0.81)。两组总并发症发生率无显著差异(P=0.60)。结论两种治疗方式均对恶性梗阻性黄疸有显著的临床疗效,但PTCD治疗有更高的手术成功率。

Objective To evaluate the clinical effect of endoscopic retrograde cholangio-pancreatography(ERCP)and percutaneous transhepatic cholangial drainage(PTCD)in the treatment of malignant obstructive jaundice by evidence-based medicine.Methods The randomized controlled trial(RCT)of ERCP or PTCD in the treatment of malignant obstructive jaundice were retrieved,the retrieval time was from the establishment of the database to August 2020.Two reviewers independently evaluated the quality of the included literatures and extracted data.RevMan 5.3 software was used for meta analysis.Results A total of 8 RCT literatures were included,with a total of 736 patients.The results of meta-analysis were as follows.For the patients with low biliary obstruction,there was no significant difference in the surgical success rate between the two groups(P=0.70);for patients with high biliary obstruction,the surgical success rate of the ERCP group was lower than that of the PTCD group(P=0.0007);the total surgical success rate of the ERCP group was lower than that of the PTCD group(P=0.008).The clinical efficacy of the ERCP group in the treatment of low biliary obstruction was better than that of the PTCD group(P=0.0001),while the clinical efficacy of the ERCP group in the treatment of high biliary obstruction was lower than that of the PTCD group(P=0.005);there was no significant difference in the total clinical efficacy between the two groups(P=0.81).There was no statistically significant difference in the total incidence of complications between the two groups(P=0.60).Conclusion Both treatments in the treatment of malignant obstructive jaundice had significant clinical effects,but the PTCD treatment had a higher surgical success rate.