Huszár Orsolya, Kokas Bálint, Mátrai Péter, Hegyi Péter, Pétervári Erika, Vincze Áron, Pár Gabriella, Sarlós Patrícia, Bajor Judit, Czimmer József, Mosztbacher Dóra, Márta Katalin, Zsiborás Csaba, Varjú Péter, Szücs Ákos
Semmelweis University, 1st Department of Surgery, Budapest, Hungary.
Institute of Bioanalysis, University of Pécs, Medical School, Pécs, Hungary.
PLoS One. 2017 Jan 11;12(1):e0169618. doi: 10.1371/journal.pone.0169618. eCollection 2017.
Benign biliary stricture is a rare condition and the majority of the cases are caused by operative trauma or chronic inflammation based on various etiology. Although the initial results of endoscopic, percutaneous and surgical treatment are impressive, no comparison about long term stricture resolution is available.
The goal of this study was to compare the long term disease free survival in benign biliary strictures with various etiology after surgery, percutaneous transhepatic-and endoscopic treatment.
PubMed, Embase, and Cochrane Library were searched by computer and manually for published studies. The investigators selected the publications according to the inclusion and exclusion criteria, processed the data and assessed the quality of the selected studies. Meta-analysis of data of 24 publications was performed to compare long term disease free survival of different treatment groups.
Compared the subgroups surgery resulted in the highest long term stricture resolution rate, followed by the percutaneous transhepatic treatment, the multiple plastic stent insertion and covered self-expanding metal stents (SEMS), however the difference was not significant. All compared methods are significantly superior to the single plastic stent placement. Long term stricture resolution rate irrespectively of any therapy is still not more than 84%.
In summary, the use of single plastic stent is not recommended. Further randomized studies and innovative technical development are required for improving the treatment of benign biliary strictures.
良性胆管狭窄是一种罕见疾病，大多数病例由手术创伤或基于各种病因的慢性炎症引起。尽管内镜、经皮和手术治疗的初始结果令人印象深刻，但尚无关于长期狭窄缓解情况的比较。
本研究的目的是比较手术、经皮肝穿刺和内镜治疗后不同病因的良性胆管狭窄患者的长期无病生存率。
通过计算机检索PubMed、Embase和Cochrane图书馆，并手动检索已发表的研究。研究人员根据纳入和排除标准选择出版物，处理数据并评估所选研究的质量。对24篇出版物的数据进行荟萃分析，以比较不同治疗组的长期无病生存率。
相比之下，手术亚组的长期狭窄缓解率最高，其次是经皮肝穿刺治疗、多个塑料支架置入和覆膜自膨式金属支架（SEMS），但差异不显著。所有比较的方法均显著优于单一塑料支架置入。无论采用何种治疗方法，长期狭窄缓解率仍不超过84%。
总之，不建议使用单一塑料支架。需要进一步的随机研究和创新技术开发来改善良性胆管狭窄的治疗。
