AIM: To analyze through meta-analyses the benefits of two types of stents in the inoperable malignant biliary obstruction.METHODS: A systematic review of randomized clinical trials(RCT) was conducted, with the last up...AIM: To analyze through meta-analyses the benefits of two types of stents in the inoperable malignant biliary obstruction.METHODS: A systematic review of randomized clinical trials(RCT) was conducted, with the last update on March 2015, using EMBASE, CINAHL(EBSCO), MEDLINE, LILACS/CENTRAL(BVS), SCOPUS, CAPES(Brazil), and gray literature. Information of the selected studies was extracted in sight of six outcomes: primarily regarding dysfunction, complication and reintervention rates; and secondarily costs, survival, and patency time. The data about characteristics of trial participants, inclusion and exclusion criteria and types of stents were also extracted. The bias was mainly assessed through the JADAD scale. This meta-analysis was registered in the PROSPERO database by the number CRD42014015078. The analysis of the absolute risk of the outcomes was performed using the software Rev Man, by computing risk differences(RD) of dichotomous variables and mean differences(MD) of continuous variables. Data on RD and MD for each primary outcome were calculated using the MantelHaenszel test and inconsistency was qualified and reported in χ2 and the Higgins method(I2). Sensitivity analysis was performed when heterogeneity was higher than 50%, a subsequent assay was done and other findings were compiled. Student's t-test was used for the comparison of weighted arithmetic means regarding secondary outcomes.RESULTS: Initial searching identified 3660 studies; 3539 were excluded through title, repetition, and/or abstract, while 121 studies were fully assessed and were excluded mainly because they did not compare self-expanding metal stents(SEMS) and plastic stents(PS), leading to thirteen RCT selected, with 13 articles and 1133 subjects meta-analyzed. The mean age was 69.5 years old, that were affected mostly by bile duct(proximal) and pancreatic tumors(distal). The preferred SEMS diameter used was the 10 mm(30 Fr) and the preferred PS diameter used was 10 Fr. In the metaanalysis, SEMS had lower overall stent dysfunction comp展开更多
目的探讨不同胆道引流方式对高位恶性胆道梗阻(malignant high biliary obstruction,MHBO)疗效的影响,为临床治疗方式的选择提供参考。方法随访MHBO患者164例,其中行胆道完全外引流18例(A组)、胆道单支架植入并对侧外引流48例(B组)、胆...目的探讨不同胆道引流方式对高位恶性胆道梗阻(malignant high biliary obstruction,MHBO)疗效的影响,为临床治疗方式的选择提供参考。方法随访MHBO患者164例,其中行胆道完全外引流18例(A组)、胆道单支架植入并对侧外引流48例(B组)、胆道优势侧引流34例(C组)、胆道双支架植入64例(D组),观察术后近、远期疗效。结果 4组患者术前ALT、AST、TBIL、DBIL与术后第3、7、14天比较,差异均有统计学意义(均P<0.05);4组患者术后第7天的组间比较,A、B、D三组下降程度高于C组,差异均有统计学意义(均P<0.05);4组患者术后第14天的组间比较,D组下降程度明显高于A、B、C三组,B组高于A、C两组,A组高于C组,差异均有统计学意义(均P<0.05)。4组患者术后第21天TBIL均值与术前比较,D组下降程度明显高于A、B、C三组,B组高于A、C两组,A组高于C组,差异均有统计学意义(均P<0.05)。4组患者术后生存期比较,D组中位生存期为(355.00±22.21)天,远高于A、B、C三组,差异均有统计学意义(均P<0.05)。结论胆道双支架植入实现了胆汁的充分内引流,对迅速消除黄疸具有明显的优越性,明显的提高了患者的生存质量及延长了生存期。展开更多
文摘AIM: To analyze through meta-analyses the benefits of two types of stents in the inoperable malignant biliary obstruction.METHODS: A systematic review of randomized clinical trials(RCT) was conducted, with the last update on March 2015, using EMBASE, CINAHL(EBSCO), MEDLINE, LILACS/CENTRAL(BVS), SCOPUS, CAPES(Brazil), and gray literature. Information of the selected studies was extracted in sight of six outcomes: primarily regarding dysfunction, complication and reintervention rates; and secondarily costs, survival, and patency time. The data about characteristics of trial participants, inclusion and exclusion criteria and types of stents were also extracted. The bias was mainly assessed through the JADAD scale. This meta-analysis was registered in the PROSPERO database by the number CRD42014015078. The analysis of the absolute risk of the outcomes was performed using the software Rev Man, by computing risk differences(RD) of dichotomous variables and mean differences(MD) of continuous variables. Data on RD and MD for each primary outcome were calculated using the MantelHaenszel test and inconsistency was qualified and reported in χ2 and the Higgins method(I2). Sensitivity analysis was performed when heterogeneity was higher than 50%, a subsequent assay was done and other findings were compiled. Student's t-test was used for the comparison of weighted arithmetic means regarding secondary outcomes.RESULTS: Initial searching identified 3660 studies; 3539 were excluded through title, repetition, and/or abstract, while 121 studies were fully assessed and were excluded mainly because they did not compare self-expanding metal stents(SEMS) and plastic stents(PS), leading to thirteen RCT selected, with 13 articles and 1133 subjects meta-analyzed. The mean age was 69.5 years old, that were affected mostly by bile duct(proximal) and pancreatic tumors(distal). The preferred SEMS diameter used was the 10 mm(30 Fr) and the preferred PS diameter used was 10 Fr. In the metaanalysis, SEMS had lower overall stent dysfunction comp
文摘目的探讨不同胆道引流方式对高位恶性胆道梗阻(malignant high biliary obstruction,MHBO)疗效的影响,为临床治疗方式的选择提供参考。方法随访MHBO患者164例,其中行胆道完全外引流18例(A组)、胆道单支架植入并对侧外引流48例(B组)、胆道优势侧引流34例(C组)、胆道双支架植入64例(D组),观察术后近、远期疗效。结果 4组患者术前ALT、AST、TBIL、DBIL与术后第3、7、14天比较,差异均有统计学意义(均P<0.05);4组患者术后第7天的组间比较,A、B、D三组下降程度高于C组,差异均有统计学意义(均P<0.05);4组患者术后第14天的组间比较,D组下降程度明显高于A、B、C三组,B组高于A、C两组,A组高于C组,差异均有统计学意义(均P<0.05)。4组患者术后第21天TBIL均值与术前比较,D组下降程度明显高于A、B、C三组,B组高于A、C两组,A组高于C组,差异均有统计学意义(均P<0.05)。4组患者术后生存期比较,D组中位生存期为(355.00±22.21)天,远高于A、B、C三组,差异均有统计学意义(均P<0.05)。结论胆道双支架植入实现了胆汁的充分内引流,对迅速消除黄疸具有明显的优越性,明显的提高了患者的生存质量及延长了生存期。
