Liu Xin-Qiang, Cui Sha-Sha, Kan Yu-Ling, Wang Jia-Fen, Xu Yuan-Shun, Zhang Feng-Qin, Rong Pan-Hao
Department of Oncology, Binzhou People's Hospital, Binzhou, China.
Department of Clinical Laboratory, Binzhou People's Hospital, Binzhou, China.
Prz Gastroenterol. 2022;17(2):116-122. doi: 10.5114/pg.2021.107798. Epub 2021 Jul 14.
Between 42% and 77% of patients with distal malignant biliary obstruction (MBO) suffer from pancreatic carcinoma (PC).
To analyse the clinical efficacy of stenting accompanied by high-intensity focused ultrasound (HIFU) ablation in patients with distal MBO from PC.
Relevant articles published through March 2021 were identified in the Pubmed, Cochrane Library, Embase, Wanfang, VIP, and CNKI databases. RevMan v5.3 and Stata v12.0 were used for the meta-analysis.
Twenty-nine articles were initially identified, and 5 of these were eventually included. These articles described 142 patients who underwent biliary stenting alone and 132 patients who underwent biliary stenting with HIFU ablation. The pooled Δ total bilirubin (TBIL) values were comparable between the 2 treatment groups ( = 0.10). The pooled stent dysfunction rate was significantly greater in the group with stenting alone ( = 0.03), and the pooled HR for the stent patency duration indicated that the duration of stent patency was increased in the stenting with HIFU ablation group ( < 0.0001). Overall survival rates were significantly longer in the stenting with HIFU ablation group ( < 0.0001). HIFU ablation was associated with an 80% pooled clinical response rate. The pooled cholangitis ( = 0.47) and pancreatitis ( = 0.56) rates were comparable between the 2 groups. Funnel plots did not reveal any significant evidence of endpoint-associated publication bias.
Stenting with HIFU ablation increased both stent patency and overall survival in patients with distal MBO caused by PC compared to stenting alone.
远端恶性胆管梗阻（MBO）患者中，42%至77%患有胰腺癌（PC）。
分析高强度聚焦超声（HIFU）消融联合支架置入术治疗PC所致远端MBO患者的临床疗效。
在Pubmed、Cochrane图书馆、Embase、万方、维普和知网数据库中检索截至2021年3月发表的相关文章。使用RevMan v5.3和Stata v12.0进行荟萃分析。
初步检索到29篇文章，最终纳入5篇。这些文章描述了142例单纯接受胆管支架置入术的患者和132例接受胆管支架置入术联合HIFU消融的患者。两个治疗组的总胆红素（TBIL）合并差值相当（ = 0.10）。单纯支架置入组的支架功能障碍合并率显著更高（ = 0.03），支架通畅持续时间的合并风险比表明，HIFU消融联合支架置入组的支架通畅持续时间增加（ < 0.0001）。HIFU消融联合支架置入组的总生存率显著更长（ < 0.0001）。HIFU消融的合并临床缓解率为80%。两组的胆管炎（ = 0.47）和胰腺炎（ = 0.56）合并率相当。漏斗图未显示终点相关发表偏倚的显著证据。
与单纯支架置入相比，HIFU消融联合支架置入可提高PC所致远端MBO患者的支架通畅率和总生存率。
