背景:壁壁坏死(WON)是一种高度病态的疾病,最有效的治疗方法是采用腔内贴壁金属(LAMS)或塑料支架进行内镜引流,并进行或不进行坏死切除术。这项荟萃分析比较了使用LAMS或塑料支架治疗的随机试验中患者的临床结果。
方法:搜索MEDLINE和EMBASE数据库,以确定从比较LAMS和塑料支架治疗WON的随机试验中收集的所有数据。主要结果指标是需要进行内窥镜坏死切除术。
结果:包含206名患者的三项研究符合纳入标准。除程序持续时间外,对于LAMS(标准化平均差[SMD]-1.22,95%CI,-1.64至-0.79),是否需要进行坏死切除术没有显着差异(38.5vs.41.2%,风险比[RR]1.07,95%CI,0.79-1.45),干预次数(SMD-0.094,95%CI,-0.40至0.22),治疗成功(90.7vs.94.5%,RR0.96,95%CI,0.87-1.06),复发(4.6vs,0.60%,RR3.73,95%CI,0.42-33.0),再入院(42.6vs.50.2%,RR0.84,95%CI,0.62-1.14),住院时间(SMD-0.062,95%CI,-0.55至0.43),死亡率(8.5vs.9.8%,RR0.70,95%CI,0.30-1.66),新发器官衰竭(10.6vs.14.6%,RR0.72,95%CI,0.16-3.32),出血(11.0vs.10.7%,RR1.09,95%CI,0.34-3.44),手术不良事件(23.6vs.19.2%,RR1.38,95%CI,0.82-2.33),或LAMS和塑料支架之间的总成本(SMD-0.035,95%CI,-0.31至0.24),分别。
结论:除程序持续时间外,使用LAMS或塑料支架治疗的WON患者的临床结局无显著差异.
BACKGROUND: Walled-off necrosis (WON) is highly morbid disease most effectively managed by endoscopic drainage with lumen-apposing metal stents (LAMSs) or plastic stents, with or without necrosectomy. This meta-analysis compared the clinical outcomes of patients included in randomized trials treated using LAMSs or plastic stents.
METHODS: The MEDLINE and EMBASE databases were searched to identify all data collected from randomized trials comparing LAMSs and plastic stents for the treatment of WON. The primary outcome measure was need for endoscopic necrosectomy.
RESULTS: Three studies comprising 206 patients met inclusion criteria. Except for procedure duration, which was significantly shorter for LAMSs (standardized mean difference [SMD] -1.22, 95%CI -1.64 to -0.79), there was no significant difference in need for necrosectomy (38.5% vs. 41.2%; risk ratio [RR] 1.07, 95%CI 0.79-1.45), number of interventions (SMD -0.09, 95%CI -0.40 to 0.22), treatment success (90.7% vs. 94.5%; RR 0.96, 95%CI 0.87-1.06), recurrence (4.6% vs. 0.6%; RR 3.73, 95%CI 0.42-33.0), readmission (42.6% vs. 50.2%; RR 0.84, 95%CI 0.62-1.14), length of hospitalization (SMD -0.06, 95%CI -0.55 to 0.43), mortality (8.5% vs. 9.8%; RR 0.70, 95%CI 0.30-1.66), new-onset organ failure (10.6% vs. 14.6%; RR 0.72, 95%CI 0.16-3.32), bleeding (11.0% vs. 10.7%; RR 1.09, 95%CI 0.34-3.44), procedural adverse events (23.6% vs. 19.2%; RR 1.38, 95%CI 0.82-2.33), or overall costs (SMD -0.04, 95%CI -0.31 to 0.24) between LAMSs and plastic stents, respectively.
CONCLUSIONS: Except for procedure duration, there is no significant difference in clinical outcomes for patients with WON treated using LAMSs or plastic stents.