评价晚期胆管癌患者姑息性R1、R2切除与支架引流治疗的疗效及光动力治疗与支架引流的疗效。

计算机检索PUBMED、中国生物医学文献数据库(CBMdisc)、万方数据库、中国学术期刊全文数据库(CNKI),查找1980年1月至2013年12月发表的有关对比分析胆管癌姑息性(R1、R2)切除与支架引流治疗及光动力治疗与支架引流治疗效果的随机对照试验文献。按照纳入与排除标准选择文献、提取资料、评价质量后,采用RevMan 5.2软件进行Meta分析。

共有9篇研究585例患者纳入姑息性R1、R2切除和支架引流分析,其中姑息性切除组208例,支架引流组377例。共有4篇研究纳入光动力治疗和支架引流分析,包括252例患者,其中光动力治疗组132例,引流治疗组120例。分析显示:总体并发症发生率、死亡率、1年生存率指标中,姑息性R1、R2切除组与引流治疗组相比1年生存人数较多,差异有统计学意义[(OR 0.79,95%CI 0.42~1.50,P=0.48)、(RD-0.00,95%CI-0.04~0.04,P=0.94)、(OR 2.87,95%CI 1.82~4.54,P<0.05)],胆瘘发生率、胆管炎或胆道梗阻发生率差异无统计学意义[(OR 1.74,95%CI 0.73~4.17,P=0.21)、(OR 0.50, 95%CI 0.22~1.12,P=0.09)]。光动力治疗组和支架引流的疗效对比中光动力治疗术后生存时间较支架引流明显延长。

晚期胆管癌患者R1、R2切除及光动力疗效均好于单纯支架引流,但光动力治疗与手术相比是一种安全、恢复快、创伤小的治疗方式。

To compare effect of palliative R1, R2 incision, drainage treatment and curative effect of photodynamic therapy with endoscopic drainage for advanced cholangiocarcinoma.

PUBMED, the Chinese Biomedical database (CBM), Wanfangdata, China academic journals full-text (CNKI) were selected for randomized controlled trials from January 1980 to December 2013 comparing efficacy of palliative (R1, R2) removal and stent therapy, and Photodynamic therapy and endoscopic drainage for bile duct cancer. In accordance with the inclusion and exclusion criteria, data quality were extracted and assessed for Meta analysis with RevMan 5.2 software.

A total of nine researches of palliative surgery and endoscopic drainage analysis, including 585 patients, were selected. Among them, 208 cases received R1 or R2 resection, and 377 cases were in the drainage treatment group. There were four researches of 252 patients about Photodynamic therapy and stent drainage analysis, including photodynamic treatment of 132 cases, and drainage treatment of 120 patients. Analysis indicated that the number of 1-year survival in the R1 or R2 resection treatment group were higher; there was statistical significance [(OR 0.79, 95% CI 0.42~1.50, P=0.48),(RD-0.00, 95%CI-0.04~0.04, P=0.94), (OR 2.87, 95% CI 1.82~4.54, P<0.05)]. Incidence of biliary fistula, cholangitis and biliary obstructions had no significant differences [(OR 1.74, 95% CI 0.73~4.17, P=0.21), (OR 0.50, 95% CI 0.22~1.12, P=0.09)]. Patients in Photodynamic therapy group showed prolonged postoprative survival than the endoscopic drainage treatment group.

For advanced bile duct carcinoma patients, both palliative R1, R2 resection and Photodynamic therapy are better than only endoscopic drainage. Meanwhile, compared with surgery, Photodynamic therapy is a more safe, quick and minimally invasive option.