胆道支架联合胆管内射频消融治疗恶性梗阻性黄疸疗效的荟萃分析

A meta-analysis of the efficacy of biliary stent combined with radiofrequency ablation in the bile duct for malignant obstructive jaundice

目的系统评价胆道支架联合胆管内射频消融与单纯支架治疗恶性梗阻性黄疸的临床效果。方法计算机检索PubMed、Cochrane library、Embase、知网、万方、维普数据库。检索日期为建库起至2021年2月。比较胆道支架联合胆管内射频消融与单纯支架治疗恶性梗阻性黄疸的临床效果。由2名研究者独立筛选文献和提取数据,进行文献质量评价后,以患者1年生存率、胆道支架术后6个月再梗阻率、术后并发症为主要结局指标进行荟萃分析。结果最终纳入9篇符合要求的文献:2篇随机试验,7篇回顾性研究。共443例患者纳入分析,211例患者采用射频消融联合胆道支架治疗(联合组),232例患者采用单纯胆道支架置入治疗(单纯组)。荟萃分析结果显示,与单纯组比较,联合组恶性梗阻性黄疸患者的支架术后6个月胆道再梗阻率降低(OR=0.24,95%CI:0.13~0.42)、1年生存率增加(OR=3.79,95%CI:2.08~6.90),差异均具有统计学意义(P<0.001);而并发症发生率间差异无统计学意义(P=0.13)。在内镜逆行胰胆管造影方式放置胆道支架的患者中,联合组支架术后再梗阻率低于单纯组(OR=0.21,95%CI:0.08~0.55),术后1年生存率高于单纯组(OR=3.63,95%CI:1.76~7.48),差异均具有统计学意义(P<0.01);在经皮经肝胆管引流方式放置胆道支架的患者中,联合组支架术后再梗阻率低于单纯组(OR=0.25,95%CI:0.12~0.51),术后1年生存率高于单纯组(OR=4.13,95%CI:1.42~12.03),差异均具有统计学意义(P<0.01)。结论与采用单纯胆道支架置入治疗相比,射频消融联合胆道支架治疗恶性梗阻性黄疸更加安全有效。

ObjectiveTo systematically evaluate the clinical effect of biliary stent combined with intra-biliary radiofrequency ablation and stent alone in the treatment of malignant obstructive jaundice.MethodsThe PubMed,Cochrane library,Embase,HowNet,Wanfang,Weipu were systematically searched,the search time was up to February 2021.To collect and compare the clinical efficacy studies of combined intra-biliary radiofrequency ablation in the treatment of patients with malignant obstructive jaundice before biliary stent placement.After literature screening,data extraction and quality assessment conducted by two independent reviewers.Meta-analysis was performed with the patients'1-year survival rate,6-month patency rate after biliary stent operation,and comparative changes in postoperative complications as the main outcome indicators.ResultsFinally,9 studies were included,comprising 2 randomized controlled studies(RCT)and 7 retrospective studies,involving a total of 443 patients,with 211 cases in the biliary stent combined with intra-biliary radiofrequency ablation group and 232 cases in the stent alone group.The results of meta-analysis showed that in two joint groups compared with the stent alone group,in overall analysis,the rate of re-obstruction of the biliary tract decreased 6 months after stenting(OR=0.24,95%CI:0.13-0.42)and 1-year survival rate increased(OR=3.79,95%CI:2.08-6.90),the differences are statistically significant(P<0.001),there was no statistical difference in the complications(P=0.13).In ERCP group,the rate of re-obstruction of the biliary tract decreased 6 months after stenting(OR=0.21,95%CI:0.08-0.55),and the 1-year survival rate significant increase(OR=3.63,95%CI:1.76-7.48),the differences are statistically significant(P<0.01).In PTCD group,the rate of re-obstruction of the biliary tract decreased 6 months after stenting(OR=0.25,95%CI:0.12-0.51),and the 1-year survival rate significant increase(OR=4.13,95%CI:1.42-12.03),the differences are statistically significant(P<0.01).ConclusionCompared with the stent-only group,the combined group is safe and effective in treating malignant obstructive jaundice.