Wang Ying, Liu Pei-Pei, Yang Lu-Lu
Department of Radiology, Xuzhou Central Hospital, Xuzhou, China.
Prz Gastroenterol. 2021;16(4):383-389. doi: 10.5114/pg.2021.105022. Epub 2021 Apr 6.
Metal stenting can be used as a primary treatment option for alleviating malignant hilar biliary obstruction (MHBO) symptoms. Although many studies have focused on the topic of unilateral or bilateral stenting for MHBO, there is a clear need for a study comparing these two stenting types in patients with a single type of cancer.
This meta-analysis was conducted to evaluate the relative clinical efficacy of unilateral and bilateral metal stent insertion for hilar cholangiocarcinoma (HCCA).
The PubMed, Embase, and Cochrane Library databases were searched to identify all relevant studies. This meta-analysis was conducted using RevMan v5.3.
We initially identified 154 studies, seven of which were included in the final meta-analysis. These studies contained 524 HCCA patients treated by either unilateral ( = 215) or bilateral ( = 309) stent insertion. No significant differences were observed between groups in rates of technical success (OR = 0.93; 95% CI: 0.34-2.54, = 0.88), clinical success (OR = 1.03; 95% CI: 0.49-2.15, = 0.94), stent dysfunction (OR = 1.47; 95% CI: 0.91-2.39, = 0.12), or survival (HR = 0.85; 95% CI: 0.50-1.42, = 0.53). However, the unilateral group exhibited significantly lower complication rates (OR = 0.34; 95% CI: 0.13-0.88, = 0.03). Significant heterogeneity was found in the endpoint of survival. Funnel plot analysis did not suggest any publication bias relating to the selected study endpoints.
Compared to bilateral metal stenting, unilateral metal stenting could provide a similar clinical efficacy for patients with HCCA with a lower complication rate.
金属支架置入术可作为缓解恶性肝门部胆管梗阻（MHBO）症状的主要治疗选择。尽管许多研究都聚焦于MHBO单侧或双侧支架置入这一话题，但显然需要一项针对单一癌症类型患者比较这两种支架置入类型的研究。
本荟萃分析旨在评估肝门部胆管癌（HCCA）单侧和双侧金属支架置入术的相对临床疗效。
检索PubMed、Embase和Cochrane图书馆数据库以识别所有相关研究。本荟萃分析使用RevMan v5.3进行。
我们最初识别出154项研究，其中7项纳入最终荟萃分析。这些研究包含524例接受单侧（n = 215）或双侧（n = 309）支架置入术治疗的HCCA患者。两组在技术成功率（OR = 0.93；95%CI：0.34 - 2.54，P = 0.88）、临床成功率（OR = 1.03；95%CI：0.49 - 2.15，P = 0.94）、支架功能障碍（OR = 1.47；95%CI：0.91 - 2.39，P = 0.12）或生存率（HR = 0.85；95%CI：0.50 - 1.42，P = 0.53）方面未观察到显著差异。然而，单侧组的并发症发生率显著更低（OR = 0.34；95%CI：0.13 - 0.88，P = 0.03）。在生存终点发现显著异质性。漏斗图分析未提示与所选研究终点相关的任何发表偏倚。
与双侧金属支架置入术相比，单侧金属支架置入术可为HCCA患者提供相似的临床疗效，且并发症发生率更低。
