光动力治疗Barrett's食管的系统评价  

Photodynamic therapy for Barrett's esophagus:a systematic review

作　　者：何继东[1] 王一平[2] 欧阳晓波[1] 

机构地区：[1]雅安市第二人民医院消化内科,四川省雅安市625000 [2]四川大学华西医院消化科,四川省成都市610041

出　　处：《世界华人消化杂志》2010年第17期1815-1819,共5页World Chinese Journal of Digestology

基　　金：国家自然科学基金资助项目;No.30271667

摘　　要：目的:系统评价光动力治疗Barrett's食管的有效性和安全性.方法:计算机全面检索Cochrane图书馆临床对照试验数据库(2009年第4期)、Medline或PubMed(1978-2010)、EMbase(1978-2010)、Ovid(1978-2010)、中国生物医学文献数据库(1978-2010)、维普中刊数据库(1989-2010)、中国期刊全文数据库(1979-2010)、万方学位论文数据库(1978-2010).手工检索《中华消化杂志》等4种相关中文期刊、相关会议论文集及所有检索到文献的参考文献.纳入光动力治疗Barrett's食管的所有随机对照试验(RCT),按Cochrane协作网推荐的方法进行系统评价.结果:共纳入10个RCT(包括731例患者),3个RCT结果显示,PDT治疗对消除轻度不典型增生安全有效(P<0.05),建议注射5-ALA后4-5h给予PDT治疗,认为低剂量PDT更为安全;3个RCT结果显示,PDT+奥美拉唑在消除Barrett's食管的重度不典型增生及减少腺癌发生上是有效的(P<0.05);3个RCT结果显示;PDT治疗Barrett's食管不典型增生效果优于APC治疗,但成本更高;1个RCT结果显示,PDT术后口服强的松不能减少食管狭窄的发生率.结论:基于目前的证据,我们认为,PDT治疗Barrett's食管的不典型增生、减少腺癌发生安全有效,推荐低剂量PDT治疗.但上述结果解释应慎重,有待进一步研究的证据.AIM：To evaluate the efficacy and safety of photodynamic therapy （PDT） for Barrett＇s esophagus （BE）.METHODS：We searched Cochrane Clinical Trial Register （Issue 4,2009）,Medline or PubMed （1978-2010）,EMBase （1978-2010）,OVID database （1978-2010）,Chinese Biological Medicine database （CBMDisc） （1978-2010）,CNKI （1979-2010）,Chinese VIP database （1989-2010） and Wanfang database （1978-2010）.We also manually searched the bibliographies of retrieved articles and four kinds of important journals to identify randomized controlled trials of PDT for BE.A systematic review was conducted using the method recommended by the Cochrane collaboration.RESULTS：Ten randomized controlled trials involving 731 patients were included in this systematic review.Three trials reported that PDT could provide safe and effective ablation of lowgrade dysplastic epithelium,and proposed that PDT could be used for the treatment of BE at 4-5 h after ALA ingestion and low-dose PDT appeared to be a safe protocol for BE.Three trials showed that PDT in combination with omeprazole was an effective therapy for ablating HGD in patients with BE and in reducing the incidence of esophageal adenocarcinoma.Three trials reported that APC and PDT were equally effective in eradicating Barrett＇s mucosa,with PDT being the more expensive treatment.However,PDT is more effective in eradicating dysplasia.One trial showed that oral prednisone after PDT did not reduce the incidence of esophageal strictures.CONCLUSION：PDT is an effective therapy for ablating HGD in patients with BE and in reducing the incidence of esophageal adenocarcinoma.Low-dose PDT is better tolerated in patients with BE.

关 键 词：光动力治疗 Barrett's食管 META分析 系统评价 随机对照试验 

分 类 号：R571[医药卫生—消化系统] R735.1[医药卫生—内科学]