ERCP与PTCD应用于恶性梗阻性黄疸疗效对比的Meta分析

Comparison of curative effect between ERCP and PTCD in treatment of malignant obstructive jaundice: a Meta-analysis

摘要:

摘要：目的??该研究是前瞻性随机对照研究（RCT）的一项Meta分析，系统评价经皮肝穿刺胆道引流术（PTCD）与内镜逆行胰胆管造影术（ERCP）两种不同姑息性引流方式应用于恶性梗阻性黄疸的疗效及安全性。方法 机算机检索从建库至2019年4月的中国知网、万方数据库、中国生物医学文献数据库、维普数据库、PubMed、MEDLINE等数据库，收集国内外ERCP与PTCD治疗恶性梗阻性黄疸的RCT。连续性变量及二分类变量分别采用均数差（MD）及比值比（OR）为效应指标，使用RevMan 5.3计算它们的合并值及95%可信区间（95%CI）。比较两种方法在手术前后总胆红素（TBil）差值、谷丙转氨酶（ALT）差值、手术成功率、术后并发症发生率方面的差异。结果 该次研究共纳入5项RCT，共282例。其中，ERCP 145例，PTCD 137例。两组手术前后TBil差异无统计学意义（MD?=?0.10，95%CI：-18.90～19.11，P?=?0.990），手术前后ALT差异无统计学意义（MD?=?7.27，95%CI：-5.25～19.80，P?=?0.260）；PTCD组手术成功率高于ERCP组（OR?=?0.33，95%CI：0.12～0.90，P?=?0.030），且术后并发症发生率也高于ERCP组（OR?=?0.33，95%CI：0.15～0.75，P?=?0.008）。结论 ERCP、PTCD两种姑息性引流方式均能有效解除恶性病变引起的胆道梗阻，从恢复肝功能、改善黄疸这两方面的临床疗效来看，ERCP组与PTCD组无明显差异。因此，对于治疗恶性梗阻性黄疸，ERCP和PTCD这两种姑息性治疗均可取得较好的疗效；但PTCD组手术成功率明显高于较ERCP组，但术后却更易发生并发症。

Abstract:

Abstract: Objective?This study is Meta analyzed of RCT. The efficacy and safety of two different palliative drainage methods, percutaneous transhepatic cholangial drainage?(PTCD) and endoscopic retrograde cholangio pancreatography?(ERCP), in malignant obstructive jaundice were systematically evaluated.?Methods?From the establishment of the database to CNKI, Wanfang Database, Chinese Biomedical Literature Database, VIP, PubMed, Medline and other databases on April 2019 were searched. Random controlled trials of ERCP and PTCD in the treatment of malignant obstructive jaundice were collected. Mean difference?(MD) and ratio oddsratio?(OR) were used as effect indexes for continuous variables and binary variables, respectively. RevMan 5.3 was used to calculate their combined values and 95%CI. The differences of TBil difference, ALT difference, success rate and postoperative complications between the two methods before and after operation were made a comparison.?Results?A total of 282 cases of RCT, were included in this study, including 145 cases of ERCP and 137 cases of PTCD. There was no significant difference in TB between the two groups before and after operation (MD?=?0.10, 95%CI: -18.90?~?19.11, P?=?0.990), while there was no significant difference in ALT before and after operation (MD?=?7.27, 95%CI: -5.25?~?19.80, P?=?0.260). The success rate of operation in PTCD group was higher than that in ERCP group (OR?=?0.33, 95%CI: 0.12?~?0.90, P?=?0.030), and the incidence of postoperative complications in ERCP group was also higher than that in ERCP group (OR?=?0.33, 95%CI: 0.15?~?0.75, P?=?0.008).?Conclusion?Alleviate bile duct obstruction caused by malignant lesions. There was no significant difference between ERCP group and PTCD group in restoring liver function and improving jaundice. Therefore, ERCP and PTCD can achieve better results in the treatment of malignant obstructive jaundice. It’s believed based on the result that the success rate of operation in PTCD group was significantly higher than that in ERCP group, however, it was more prone to have complicating disease after operation.