覆膜自膨式金属支架 (C-SEMS) 用于恶性肝门部胆道梗阻 (MHBO) 的治疗。尽管证据不断增加，但仍缺乏对 C-SEMS 在 MHBO 治疗中的有效性和安全性的全面评估。截至 2024 年 3 月 31 日，PubMed、EMBASE 和 Cochrane 图书馆筛选了包括 C-SEMS 治疗的 MHBO 在内的研究。选择符合预定纳入标准的研究，包括接受 C-SEMS 放置治疗的成年 MHBO 患者，报告技术成功、临床成功和不良事件发生率。使用随机效应模型进行数据合成和统计分析，并进行异质性和发表偏倚评估。401 篇文章中纳入了 7 项研究。 C-SEMS 的技术和临床合并成功率为 96.7%（95% CI 92.6-98.6%，I2=0%）和 91.6%（95% CI 86.1-95.0%，I2=0%）。 16.6%（95% CI 11.2-23.9%，I2=24%）的病例报告了总体不良事件，其中包括胆管炎（7.4%）、胰腺炎（5.9%）、肝脓肿（5.9%）和胆囊炎（2.8%） ）。支架移位和复发性胆道梗阻的发生率分别为 8.9% 和 49.6%，复发性胆道梗阻的中位时间为 142 天。 92.5% 的病例再次干预成功（95% CI 83.1-96.9%，I2=0%） 结论：我们的荟萃分析显示 C-SEMS 在 MHBO 中的技术和临床成功率很高。不良事件，特别是胆管炎、胆囊炎和胰腺炎的发生率<10%。通过 C-SEMS 移除和成功的再干预，RBO 和支架迁移得到缓解。我们的研究结果强调了 C-SEMS 在治疗 MHBO 方面的有效性和安全性，值得进一步研究以优化治疗策略。版权所有 © 2024 美国胃肠内窥镜协会。由爱思唯尔公司出版。保留所有权利。

Covered self-expanding metal stents (C-SEMS) are used for malignant hilar biliary obstruction (MHBO) management. Despite increasing evidence, comprehensive evaluation of the efficacy and safety of C-SEMS in MHBO management is lacking.PubMed, EMBASE, and the Cochrane Library were screened up to March 31, 2024 for studies including MHBO treated by a C-SEMS. Studies meeting predefined inclusion criteria, including adult MHBO patients treated with C-SEMS placement, reporting technical success, clinical success, and adverse event rates, were selected. Data synthesis and statistical analysis were performed using the random effects model, with heterogeneity and publication bias assessment.From 401 articles, seven studies were included. Pooled technical and clinical success rate of C-SEMS was 96.7% (95% CI 92.6-98.6%, I2=0%) and 91.6% (95% CI 86.1-95.0%, I2=0%). Overall adverse events were reported in 16.6% (95% CI 11.2-23.9%, I2=24%) of cases which included cholangitis (7.4%), pancreatitis (5.9%), liver abscess (5.9%), and cholecystitis (2.8%). Stent migration and recurrent biliary obstruction were observed in 8.9% and 49.6% of cases, respectively, with a median time to recurrent biliary obstruction of 142 days. Reintervention was successful in 92.5% of cases (95% CI 83.1-96.9%, I2=0%) CONCLUSION: Our meta-analysis revealed high technical and clinical success rates of C-SEMS in MHBO. Adverse events, notably cholangitis, cholecystitis, and pancreatitis were <10%. RBO and stent migration was mitigated by C-SEMS removal and successful reintervention. Our findings highlight the efficacy and safety of C-SEMS in managing MHBO, warranting further research to optimize treatment strategies.Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.