Aghaie Meybodi Mohamad, Shakoor Delaram, Nanavati Julie, Ichkhanian Yervant, Vosoughi Kia, Brewer Gutierrez Olaya I, Kalloo Anthony N, Singh Vikesh, Kumbhari Vivek, Ngamruengphong Saowanee, Khashab Mouen A
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, United States.
Endosc Int Open. 2020 Mar;8(3):E281-E290. doi: 10.1055/a-1067-4326. Epub 2020 Feb 21.
Endoscopic stent placement is used for palliative management of unresectable malignant hilar obstruction, which could be achieved by either unilateral or bilateral stent insertion. A literature search was performed to identify studies that reported outcomes of metallic biliary stent placement in patients with malignant hilar obstruction. Weighted pooled rates (WPR) along with 95 % confidence intervals (95 %CI) were calculated to determine and compare outcomes including technical and functional success, early and late adverse events, post procedure cholangitis, and stent occlusion between two groups. A total of 21 studies with 1292 patients were included. WPR of technical success was significantly higher in the unilateral group (97 %, 95 %CI: 93 -98 %) vs. bilateral group (89 %, 95 %CI: 84 -92 %) ( = 0.0.003). WPR for functional success in the unilateral and bilateral groups were 96 % (95 %CI: 91 -98 %) and 94 % (95 %CI: 91 -97 %), respectively ( = 0.48). The rate of early and late complications was comparable between the two groups. In patients with unresectable malignant hilar obstruction, unilateral and bilateral metallic stenting techniques are comparable in terms of efficacy and safety.
内镜下支架置入术用于不可切除的恶性肝门梗阻的姑息治疗，可通过单侧或双侧支架置入来实现。进行文献检索以确定报告恶性肝门梗阻患者金属胆道支架置入术结果的研究。计算加权合并率（WPR）以及95%置信区间（95%CI），以确定和比较两组之间的技术成功率、功能成功率、早期和晚期不良事件、术后胆管炎以及支架闭塞等结果。共纳入21项研究，涉及1292例患者。单侧组的技术成功率加权合并率显著高于双侧组（97%，95%CI：93%-98%） vs. 双侧组（89%，95%CI：84%-92%）（P = 0.003）。单侧组和双侧组的功能成功率加权合并率分别为96%（95%CI：91%-98%）和94%（95%CI：91%-97%）（P = 0.48）。两组的早期和晚期并发症发生率相当。对于不可切除的恶性肝门梗阻患者，单侧和双侧金属支架置入技术在疗效和安全性方面相当。
