比较125I粒子支架与普通胆管支架在不可切除 胆管癌患者姑息治疗中疗效的Meta分析

2020-08-21 08:52:38 中国现代医生 2020年18期

黄智聪 王桂良 林秋满 龚敏 邱萍 徐林芳 李兴 文剑波

[摘要] 目的 比较125I粒子支架与普通胆管支架在不能切除的胆管癌患者姑息治疗中的作用。 方法 在PubMed,MEDLINE,EMBASE、Cochrane Library、中国知网数据库系统检索2000年1月~2019年12月所有关于对125I粒子支架和普通胆管支架在不能手术切除的胆管癌治疗进行疗效比较的随机对照试验。观察分析两组的总胆红素水平、支架通畅持续时间、生存时间和并发症的发生率。 结果 与普通支架组相比,125I组术后的总胆红素水平显著降低(P<0.05)、生存时间(P<0.00001)及支架通畅时间(P<0.00001)均明显延长,而并发症发生率(P>0.05)无统计学意义。 结论 与普通支架相比,125I粒子支架可以降低不可切除胆管癌患者的总胆红素水平,延长支架通畅时间和患者生存时间,且不增加并发症发生率,效果更佳。

[关键词] 125I粒子支架;胆道支架;胆管癌;Meta分析

[中图分类号] R657.4          [文献标识码] A          [文章编号] 1673-9701(2020)18-0023-05

Meta-analysis of curative effect comparison between 125I particle stent and ordinary biliary stent in palliative treatment of patients with unresectable cholangiocarcinoma

HUANG Zhicong   WANG Guiliang   LIN Qiuman   GONG Min   QIU Ping   XU Linfang   LI Xing   WEN Jianbo

Department of Gastroenterology, Affiliated Pingxiang Hospital, Southern Medical University, Pingxiang   337000, China

[Abstract] Objective To compare the effect of 125I particle stent and ordinary biliary stent in palliative treatment of patients with unresectable cholangiocarcinoma. Methods All randomized controlled trials comparing the efficacy of 125I particle stent and ordinary biliary stent in the treatment of surgically unresectable cholangiocarcinoma were retrieved in PubMed, MEDLINE, EMBASE, Cochrane Library, China HowNet database systems from January 2000 to December 2019. The total bilirubin level, duration of stent patency, survival time and incidence of complications in both groups were observed and analyzed. Results Compared with that of the ordinary stent group, the total bilirubin level in the 125I group was significantly reduced(P<0.05), survival time(P<0.00001) and stent patency time(P<0.00001) were significantly prolonged, while the incidence of complications(P>0.05) was not statistically significant. Conclusion Compared with ordinary stents, 125I particle stent can reduce the total bilirubin level in patients with unresectable cholangiocarcinoma, prolong the stent patency time and patient survival time without increasing the incidence of complications, and its effect is better.

[Key words] 125I particle stent; Biliary stent; Cholangiocarcinoma; Meta analysis

膽管癌为起源于胆管上皮细胞(包括肝内、肝门和肝外)的腺癌,死亡率极高,与多种病因有关,例如:乙型肝炎、丙型肝炎、艾滋病、肝内胆管结石、肝硬化、多发性硬化、胆管炎、寄生虫感染、化学致癌物、肥胖、II型糖尿病和非酒精性脂肪肝[1]等。如果仅予以姑息治疗,胆管癌患者的中位生存时间低至2~6个月。化疗和放疗对患者的生存期延长以及生活质量的改善效果并不理想[2],目前经皮穿刺或经鼻插入胆道支架进行姑息性胆管减压是一种可行的方案[3]。普通塑料支架或金属支架对不能切除的胆管癌并没有治疗作用,而放射性粒子支架却可以达到治疗的目的[4]。125I粒子可通过破坏DNA双链螺旋,抑制肿瘤细胞复制,诱导CD3+和CD4+细胞活化,从而诱导肿瘤细胞凋亡产生抗肿瘤免疫反应[5]。本研究通过Meta分析方法对125I粒子和普通胆管支架对不可切除的胆管癌患者的生存结果、疗效和安全性进行分析,现报道如下。

本研究使用Meta分析比較了普通胆道支架和125I粒子支架组对不能切除的胆管癌的影响,发现与普通支架组相比125I粒子支架组总胆红素显著性下降、支架通畅率显著性增加、患者生存时间延长,这说明125I粒子支架组可显著性提高支架通畅率和存活时间。两组间并发症的比例无显著性差异,表明125I粒子支架组与普通胆管支架一样安全,副作用小。

这项荟萃分析首次表明,与普通胆道支架相比,125I粒子支架在不可切除的胆管癌患者中的作用优于普通胆道支架,主要体现在它可以降低总胆红素、延长支架通畅时间、患者生存时间、而不增加并发症率。这项研究有下列局限性:样本量较小,125I粒子可能具有潜在的副作用,包括严重疼痛、胰腺炎、胆道穿孔、感染、支架移位,但作者没有发现或报告,也可能是因为样本量偏少。因此,应进行大样本的精心设计的随机对照试验,并进行广泛的随访,以确认和更新该分析的结果。

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