School of Nursing, Binzhou Medical University, No. 522 Huanghe-three Road, Binzhou, 255600, China.
Department of Infectious Diseases, Binzhou Medical University Hospital, Binzhou, China.
Abdom Radiol (NY). 2021 May;46(5):2173-2181. doi: 10.1007/s00261-020-02851-6. Epub 2020 Nov 6.
The purpose of the study was to compare the relative clinical efficacies of irradiation stent (IRS) and conventional stent (CVS) insertions for the treatment of patients with malignant biliary obstruction (MBO). Pubmed, Embase, and Cochrane Library databases were searched for relevant randomized controlled trials (RCTs) from the date of inception through to August 2020. Data analysis was performed using RevMan v5.3. This meta-analysis included eight RCTs which included a total of 319 patients who had undergone IRS insertion, and 328 who had undergone CVS insertion. No significant differences in pooled Δ total bilirubin values (MD 0.34; P = 0.92), incident rates of cholangitis (P = 0.47), hemobilia (P = 0.60), or pancreatitis (P = 0.89) were detected between two groups. The rate of stent dysfunction was significantly lower in the IRS group compared to the CVS group (22.2% vs. 37.7%, P = 0.02). The pooled stent patency (P < 0.00001) and survival (P < 0.00001) were significantly longer in the IRS group compared to the CVS group. Significant heterogeneity was detected in the endpoints of rate of stent dysfunction (I = 52%; P = 0.08) and survival (I = 77%; P = 0.0005). Subgroup analysis was performed based on the different IRS types and showed significantly longer survival in the IRS group based on both types of IRS. Funnel plot analyses did not detect any evidence of publication bias. This meta-analysis included eight RCTs which included a total of 319 patients who had undergone IRS insertion, and 328 who had undergone CVS insertion. No significant differences in pooled Δ total bilirubin values (MD 0.34; P = 0.92), incident rates of cholangitis (P = 0.47), hemobilia (P = 0.60), or pancreatitis (P = 0.89) were detected between 2 groups. The rate of stent dysfunction was significantly lower in the IRS group compared to the CVS group (22.2% vs. 37.7%, P = 0.02). The pooled stent patency (P < 0.00001) and survival (P < 0.00001) were significantly longer in the IRS group compared to the CVS group. Significant heterogeneity was detected in the endpoints of rate of stent dysfunction (I = 52%; P = 0.08) and survival (I = 77%; P = 0.0005). Subgroup analysis was performed based on the different IRS types and showed significantly longer survival in the IRS group based on both types of IRS. Funnel plot analyses did not detect any evidence of publication bias. Our meta-analysis demonstrates that IRS insertion can prolong stent patency and the survival of patients with MBO compared to CVS insertion.
本研究旨在比较放疗支架（IRS）和传统支架（CVS）插入治疗恶性胆道梗阻（MBO）患者的相对临床疗效。从研究开始到 2020 年 8 月，通过 Pubmed、Embase 和 Cochrane Library 数据库搜索相关的随机对照试验（RCT）。使用 RevMan v5.3 进行数据分析。这项荟萃分析包括 8 项 RCT，共纳入 319 例接受 IRS 插入治疗的患者和 328 例接受 CVS 插入治疗的患者。两组间总胆红素差值（MD 0.34；P = 0.92）、胆管炎发生率（P = 0.47）、血胆症（P = 0.60）或胰腺炎发生率（P = 0.89）无显著差异。IRS 组的支架功能障碍发生率显著低于 CVS 组（22.2%比 37.7%，P = 0.02）。IRS 组的支架通畅率（P < 0.00001）和生存率（P < 0.00001）明显长于 CVS 组。支架功能障碍（I = 52%；P = 0.08）和生存率（I = 77%；P = 0.0005）终点存在显著异质性。根据不同的 IRS 类型进行亚组分析，结果显示 IRS 组的生存率明显更长。漏斗图分析未发现任何发表偏倚的证据。这项荟萃分析包括 8 项 RCT，共纳入 319 例接受 IRS 插入治疗的患者和 328 例接受 CVS 插入治疗的患者。两组间总胆红素差值（MD 0.34；P = 0.92）、胆管炎发生率（P = 0.47）、血胆症（P = 0.60）或胰腺炎发生率（P = 0.89）无显著差异。IRS 组的支架功能障碍发生率显著低于 CVS 组（22.2%比 37.7%，P = 0.02）。IRS 组的支架通畅率（P < 0.00001）和生存率（P < 0.00001）明显长于 CVS 组。支架功能障碍（I = 52%；P = 0.08）和生存率（I = 77%；P = 0.0005）终点存在显著异质性。根据不同的 IRS 类型进行亚组分析，结果显示 IRS 组的生存率明显更长。漏斗图分析未发现任何发表偏倚的证据。我们的荟萃分析表明，与 CVS 插入相比，IRS 插入可以延长 MBO 患者的支架通畅率和生存率。
