急性重症胆管炎行ENBD与PTCD疗效比较的meta分析

Meta-analysis of therapeutic efficacy comparison between ENBD and PTCD for acute cholangitis of severe type

目的评价内镜下鼻胆管引流术(ENBD)与经皮经肝胆管穿刺引流术(PTCD)两种胆道引流方式对急性重症胆管炎的临床疗效并探讨其临床应用价值。方法检索PubMed、EMBASE、Medline、Web of Science、中国知网、万方数据知识服务平台数据库中发表的关于急性重症胆管炎行ENBD与PTCD治疗效果比较的临床研究。检索时间为2010年1月1日至2023年8月31日。观察指标包括手术时间、住院时间、有效率、病死率及总并发症发生率,提取相关数据后用RevMan 5.4软件进行meta分析。结果共纳入符合标准的5篇回顾性队列研究,文献累计样本量为345例,其中ENBD组191例,PTCD组154例。meta分析结果显示,两组住院时间[WMD=-0.96,95%CI(-1.92,0.01),P=0.05]、病死率[OR=0.87,95%CI(0.43,1.73),P=0.68]比较,差异无统计学意义(P>0.05)。ENBD组有效率高于PTCD组[OR=2.43,95%CI(1.09,5.44),P=0.03],PTCD组总并发症发生率高于ENBD组[OR=0.33,95%CI(0.14,0.74),P=0.007],差异有统计学意义(P<0.05)。结论对于急性重症胆管炎患者行ENBD临床治疗效果优于PTCD,是一种安全、有效的胆管引流方式。

Objective To evaluate the clinical efficacy of endoscopic nasobiliary drainage(ENBD)and percutaneous transhepatic cholangial drainage(PTCD)as two types of bile duct drainage methods in the treatment of acute cholangitis of severe type(ACST),so as to investigate their clinical application value.Methods Database for clinical research on the comparison of therapeutic efficacy between ENBD and PTCD on ACST were retrieved in PubMed,EMBASE,Medline,Web of Science,CNKI and Wanfang.The retrieval time was from January 1,2010 to August 31,2023.The observation indices include operation time,hospitalization time,response rate,mortality rate and total incidence of complications.After extracting the relevant data,meta-analysis was carried out with RevMan 5.4 software.Results A total of 5 retrospective cohort conforming research were included,with a literature cumulative sample size of 345 cases,and they were divided into the ENBD group(n=191)and the PTCD group(n=154).Meta-analysis results showed that there were no statistically significant differences in hospitalization time(WMD=-0.96,95%CI[-1.92,0.01],P=0.05)and mortality rate(OR=0.87,95%CI[0.43,1.73],P=0.68)between the two groups(P>0.05).The response rate(OR=2.43,95%CI[1.09,5.44],P=0.03)in the ENBD group was higher than that in the PTCD group,and the total incidence of complications(OR=0.33,95%CI[0.14,0.74],P=0.007)in the PTCD group was higher than that in the ENBD group,with statistically significant differences(P<0.05).Conclusion For patients with ACST,the clinical treatment efficacy of ENBD is superior to that of PTCD,which is a safe and effective way of bile duct drainage.