Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
ANZ J Surg. 2021 Jul;91(7-8):E446-E454. doi: 10.1111/ans.16899. Epub 2021 Apr 27.
Although routine preoperative biliary drainage (PBD) is generally not recommended for patients with malignant distal biliary obstruction (MDBO), it is still necessary in many cases. The objective of this study is to compare the effects of metal stents (MSs) and plastic stents (PSs) on PBD in patients with MDBO.
All the randomized controlled trials (RCTs) that compared MS with PS for PBD and published from the date of database establishment to September 2020 were identified by searching the PubMed, EMBASE and Cochrane databases.
Five RCTs involving 445 patients were included. There were 201 cases in the MS group, with 244 in the PS group. Re-interventions (relative risk (RR) = 0.40, 95% confidence interval (CI) 0.21-0.75, P = 0.004), stent occlusions (RR = 0.36, 95% CI 0.18-0.75, P = 0.006), postoperative complications (RR = 0.76, 95% CI 0.59-0.97, P = 0.03) and preoperative cholangitis (RR = 0.19, 95% CI 0.05-0.78, P = 0.02) were lower in the MS group than in the PS group. Preoperative pancreatitis (RR = 2.11, 95% CI 1.06-4.19, P = 0.03) was higher in the MS group than in the PS group. No significant difference was observed in the overall preoperative complications, postoperative pancreatic fistulas, delayed gastric emptying, wound infections and postoperative bleeding between these two groups.
MS and PS exerted a similar effect on PBD, but PS had a higher risk of preoperative stent obstruction and postoperative complications, requiring more frequent interventions preoperatively. However, larger sample and higher quality RCTs are necessary for further verification.
虽然常规术前胆道引流（PBD）一般不推荐用于恶性远端胆道梗阻（MDBO）患者，但在许多情况下仍有必要。本研究旨在比较金属支架（MS）和塑料支架（PS）对 MDBO 患者 PBD 的影响。
通过检索 PubMed、EMBASE 和 Cochrane 数据库，确定了自数据库建立日期至 2020 年 9 月比较 MS 与 PS 用于 PBD 的所有随机对照试验（RCT）。
共纳入 5 项 RCT，共 445 例患者。MS 组 201 例，PS 组 244 例。再次干预（相对风险（RR）=0.40，95%置信区间（CI）0.21-0.75，P=0.004）、支架阻塞（RR=0.36，95%CI 0.18-0.75，P=0.006）、术后并发症（RR=0.76，95%CI 0.59-0.97，P=0.03）和术前胆管炎（RR=0.19，95%CI 0.05-0.78，P=0.02）在 MS 组中低于 PS 组。MS 组术前胰腺炎（RR=2.11，95%CI 1.06-4.19，P=0.03）高于 PS 组。两组患者术前总体并发症、术后胰瘘、胃排空延迟、伤口感染和术后出血无显著差异。
MS 和 PS 对 PBD 的作用相似，但 PS 术前支架阻塞和术后并发症的风险较高，需要更频繁的术前干预。然而，需要更大样本量和更高质量的 RCT 来进一步验证。
