内镜下乳头球囊扩张术对比乳头括约肌切开术治疗胆总管结石的Meta分析  

Endoscopic balloon sphincter dilation vs. sphincterotomy for common bile duct stones： a Metaanalysis

作　　者：鲁超[1] 锁涛[1] 付亮[1] 张钰[1] 宋陆军[1] 

机构地区：[1]复旦大学附属中山医院普外科,上海200032

出　　处：《中华消化内镜杂志》2013年第4期202-208,共7页Chinese Journal of Digestive Endoscopy

摘　　要：目的对比内镜下乳头球囊扩张术（EPBD）与内镜乳头括约肌切开术（EST）治疗胆总管结石的利与弊。方法检索Cochrane Library、Embase、Medline、Pubmed、CBM、CNKI、VIP和万方数据库，没有语言限制。纳入从1983年1月到2012年9月间发表的比较EPBD与EST治疗胆总管结石的临床随机对照实验，并对其进行了质量学评价，最后用RevMan5．1软件进行Meta分析。结果18个临床随机对照实验符合研究标准（2385个研究对象）。在第一次成功取石率、总成功取石率、穿孔、长期胆管炎发生率等方面EPBD与EST结果类似。EPBD有更高的危险发生胰腺炎（RR=1．99，95％CI：1．41-2．81）和重症胰腺炎（RR=4．68，95％CI：1．36～16．11），需要机械碎石的概率更高（RR=1．31，95％CI：1．14～1．50）。相反的是，EPBD不但有明显低的出血率（RR=0．14，95％CI：0．06～0．34），而且长期结石复发（RR=0．67，95％CI：0．47～0．96），长期胆囊炎（RR=0．38，95％CI：0．19-0．76）和总的长期并发症（RR=0．52，95％CI：0．40～0．67）发生率更低。结论考虑出血、结石复发或长期并发症的话，相对于EST，EPBD治疗胆总管结石是更好的选择；但后者胰腺炎尤其是重症胰腺炎的发生率更高。Objective To compare the pros and cons of endoscopic papillary balloon dilation （EPBD） with those of endoscopic sphincterotomy （EST） in the treatment of common bile duct stones. Methods We searched The Cochrane library, Medline, Pubmed, Embase, CBM, CNKI, VIP and Wan Fang database in any language. RCTs that compared EPBD with EST for the removal of common bile duct stones were included from January 1983 to September 2012 and qualities of the trials were evaluated. Statistic analyses were carried out using RevMan 5.1 software. Results A total of 18 randomized trials with 2385 participants met our inclusion criteria. EPBD compared with EST resulted in similar outcomes with regards to stone removal on 1 st attempt, overall stone removal, perforation, total short-term complication, long-term cholangitis or mortality. EPBD carries a higher risk of panereatitis （RR = 1.99, 95% CI： 1.41-2. 81 ） and severe pancreatitis （RR = 4. 68,95 % CI： 1.36-16. 11 ） , and requires higher rates of mechanical lithotripsy （RR = 1.31,95% CI： 1.14-1.50）. Conversely, EPBD not only has statistically significant lower rates of bleeding （RR = 0. 14,95 % CI：0. 06-0. 34 ）, but also leads to significantly less long-term choleeystitis （RR = 0. 38,95%CI：0. 19-0. 76）, long-term stone recurrence （RR =0. 67,95% CI：0. 47-0. 96） and total longterm complications （RR =0. 52,95% CI：0. 40-0. 67）. Conclusion On the basis of lower rates of bleeding or long-term complications, EPBD should be the preferred strategy over EST for endoscopic management of common bile duct stones, however, the rate of panereatitis, especially the severe panereatitis is higher with EPBD.

关 键 词：胆总管结石 括约肌切开术 内窥镜 内镜下乳头球囊扩张术 META分析 

分 类 号：R657[医药卫生—外科学]