Puli Srinivas R, Kalva Nikhil, Pamulaparthy Smitha R, Bechtold Matthew L, Cashman Micheal D, Volmar Fritz-Henry, Dhillon Sonu, Shekleton Michael F, Estes Norman C, Carr-Locke David
Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, 61614, USA,
Indian J Gastroenterol. 2013 Nov;32(6):355-62. doi: 10.1007/s12664-013-0413-3. Epub 2013 Oct 25.
Stents are used for palliating inoperable malignant bile duct hilar obstruction. It is not clear if bilateral stenting provides any advantage over unilateral stenting in these patients. Compare bilateral and unilateral stenting in malignant hilar obstruction.
Studies using stents for palliation in patients with malignant hilar obstruction were selected.
Articles were searched in MEDLINE, PubMed, Ovid journals, CINAH, International Pharmaceutical Abstracts, OLDMEDLINE, MEDLINE nonindexed citations, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Two reviewers independently searched and extracted data. Any differences were resolved by mutual agreement.
Pooled proportions were calculated using both the Mantel-Haenszel method (fixed effects model) and DerSimonian-Laird method (random effects model). The heterogeneity among studies was tested using Cochran's Q test based upon inverse variance weights. The initial search identified 1,640 reference articles, of which 169 were selected and reviewed. Thirteen studies (n = 340) for bilateral metallic stents, eight studies (n = 575) for unilateral metallic stents, eight studies (n = 367) for bilateral plastic stenting, and seven studies (n = 850) for unilateral plastic stenting which met the inclusion criteria were included in this analysis. Pooled data are shown in Tables 1 and 2. The pooled estimates by the fixed and random effect models were similar. The p for chi-squared heterogeneity for all the pooled accuracy estimates was >0.10. Bilateral metal stenting seems to have lower odds of overall complications when compared to unilateral metallic stenting. Bilateral metal stents seem to have higher odds of lowering bilirubin than unilateral metal stents, but the 30-day mortality was no different. For metal stents, bilateral metal stents are superior in palliating symptoms due to hyperbilirubinemia. Unilateral plastic stenting seems to have similar odds of overall complications, cholangitis, and 30-day mortality when compared to bilateral plastic stenting for malignant hilar strictures. In patients with malignant hilar stricture, unilateral plastic stenting is comparable to bilateral plastic stenting for adverse events.
支架用于缓解无法手术的恶性胆管肝门部梗阻。在这些患者中，双侧支架置入是否比单侧支架置入具有任何优势尚不清楚。比较恶性肝门部梗阻的双侧和单侧支架置入。
选择使用支架缓解恶性肝门部梗阻患者症状的研究。
在MEDLINE、PubMed、Ovid期刊、CINAHL、国际药学文摘、OLDMEDLINE、MEDLINE非索引引文以及Cochrane对照试验中心注册库和系统评价数据库中检索文章。两名评审员独立检索并提取数据。任何差异通过相互协商解决。
使用Mantel-Haenszel法（固定效应模型）和DerSimonian-Laird法（随机效应模型）计算合并比例。基于逆方差权重，使用Cochrane Q检验检验研究间的异质性。初步检索确定了1640篇参考文献，其中169篇被选择并进行评审。本分析纳入了13项研究（n = 340）用于双侧金属支架，8项研究（n = 575）用于单侧金属支架，8项研究（n = 367）用于双侧塑料支架置入，7项研究（n = 850）用于单侧塑料支架置入，这些研究均符合纳入标准。合并数据见表1和表2。固定效应模型和随机效应模型的合并估计值相似。所有合并准确性估计值的卡方异质性p值>0.10。与单侧金属支架置入相比，双侧金属支架置入总体并发症的发生率似乎更低。双侧金属支架降低胆红素水平的几率似乎高于单侧金属支架，但30天死亡率无差异。对于金属支架，双侧金属支架在缓解高胆红素血症引起的症状方面更具优势。与用于恶性肝门部狭窄的双侧塑料支架置入相比，单侧塑料支架置入总体并发症、胆管炎和30天死亡率的发生率似乎相似。在恶性肝门部狭窄患者中，单侧塑料支架置入在不良事件方面与双侧塑料支架置入相当。
