SpyGlass治疗难治性胆管结石有效性和安全性的Meta分析

目的 评价SpyGlass治疗难治性胆管结石（DBDS）的有效性和安全性，并比较第一代与第二代SpyGlass、液电碎石与激光碎石治疗DBDS的疗效差异。方法 检索多个中英文数据库建库至2021年2月的研究。通过纽卡斯尔-渥太华量表（NOS）和JADAD量表评估不同类型研究的方法学质量，并使用随机效应模型合并效应量。重要结局包括结石完全清除率、结石单次清除率、取石次数和不良事件发生率。结果 最终37项研究符合纳入标准，包含3 728例患者。结石完全清除率为0.947（95%CI：0.920～0.970），结石单次清除率为0.747（95%CI：0.682～0.807），取石次数为1.10次（95%CI：1.080～1.120），不良事件发生率为0.065（95%CI：0.046～0.087）；二代SpyGlass在结石完全清除率、结石单次清除率、取石次数上优于一代SpyGlass（97.3%和92.2%、80.3%和67.8%、1.03和1.27次）；激光碎石在结石完全清除率、结石单次清除率、取石次数、不良事件发生率上优于液电碎石（97.8%和91.0%、80.4%和70.1%、1.06和1.19次、6.5%和7.8%）。结论 常规取石方法失败时，SpyGlass是治疗DBDS的一种安全有效的方法，二代SpyGlass结合激光碎石可能会得到更好的疗效。

Efficacy and safety of SpyGlass treating difficult bile duct stones: a Meta-analysis

Objective To evaluate the efficacy and safety of SpyGlass, in addition, to compare the efficacy of first/second-generation SpyGlass, electrohydraulic and laser lithotripsy in treating difficult bile duct stones.Methods Several Chinese and English databases were searched up to February 2021. The methodological quality of studies was evaluated by Newcastle-Ottawa Scale (NOS) and JADAD scale, and random-effects models were used to calculate the pooled estimates. Important outcomes were complete stone clearance rate, single-session stone clearance rate, stone removal times and adverse events rate.Results 37 studies met the inclusion criteria, involving 3 728 patients. The complete stone clearance rate was 0.947 (95%CI: 0.920 ~ 0.970), the single-session stone clearance rate was 0.747 (95%CI: 0.682 ~ 0.807), the stone removal times was 1.10 (95%CI: 1.080 ~ 1.120), and the adverse events rate was 0.065 (95%CI: 0.046 ~ 0.087); The second-generation SpyGlass is superior to the first-generation SpyGlass in the complete/single-session stone clearance rate and the stone removal times (97.3% vs 92.2%, 80.3% vs 67.8%, 1.03 vs 1.27); Electrohydraulic lithotripsy is superior to laser lithotripsy in the complete/single-session stone clearance rate, the stone removal times and the adverse events rate (97.8% vs 91.0%, 80.4% vs 70.1%, 1.06 vs 1.19, 6.5% vs 7.8%).Conclusion SpyGlass is a safe and effective treatment for difficult bile duct stones when conventional stone removal has failed, the second-generation SpyGlass combined with laser lithotripsy may get a better effect.