早期ERCP与早期保守治疗重症急性胆源性胰腺炎的系统综述及Meta分析  

Early ERCP vs early conservative management in patients with severe acute biliary pancreatitis:A systematic review and Metaanalysis

作　　者：莫晨[1,2] 孙刚[2] 张丽[2] 路明亮[2] 王艳芝[2] 徐铭宝[1] 杨云生[2] 

机构地区：[1]武警总医院干部病房二科,北京市100039 [2]中国人民解放军总医院消化病中心,北京市100853

出　　处：《世界华人消化杂志》2015年第5期813-822,共10页World Chinese Journal of Digestology

摘　　要：目的:系统评价早期内镜逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatgraphy,ERCP)治疗重症急性胆源性胰腺炎(sever acute biliary pancreatitis,SABP)的疗效及安全性.方法:计算机检索Pubmed、EMbase、Cochrane Central Register of Controlled Trials、中国知网(CNKI)、万方和中国生物医学文献数据库(CBM),查找所有比较早期ERCP治疗与早期保守治疗SABP疗效的随机对照试验(randomized controlled trial,RCT),检索起止时间均为从建库至2014-06.由两名研究者独立进行文献筛选、资料提取并应用Cochrane偏倚风险工具进行质量评价,采用Revman5.1软件进行Meta分析.结果:最终纳入10个RCT,共809例患者.Meta分析结果显示:对于SABP患者,与保守治疗相比,早期ERCP治疗可降低病死率(RR=0.22,95%CI:0.10-0.47)及器官衰竭的发生率(RR=0.45,95%CI:0.28-0.71),缩短腹痛缓解时间(MD=-4.74,95%CI:-5.32--4.17)及住院时间(MD=-13.49,95%CI:-14.64--12.33).结论:早期ERCP治疗SABP安全有效,建议早期ERCP治疗SABP.AIM：To assess the efficacy and safety of early endoscopic retrograde cholangiopancreatography（ERCP） in the management of severe acute biliary pancreatitis（SABP）.METHODS：Electronic databases including PubMed,Embase,Cochrane Central Register of Controlled Trials,CNKI,CBM and WanFang Data were searched from inception to June 30,2014 to retrieve randomized controlled trials（RCTs） comparing early ERCP intervention vs early conservative management in SABP patients.Two reviewers independently screened the articles and extracted relevant information.Study quality was assessed using the Cochrane risk-of-bias tool.Meta-analysis was performed using RevMan 5.1 software.RESULTS：A total of 10 RCTs involving 809 patients were included.The results of Metaanalysis showed that early ERCP strategy significantly reduced mortality（RR = 0.22,95%CI：0.10-0.47）,organ failure rate（RR =0.45,95%CI：0.28-0.71）,the time to abdominal pain relief（MD =-4.74,95%CI：-5.32-4.17） and the hospitalization time（MD =-13.49,95%CI：-14.64-12.33）.CONCLUSION：Early ERCP strategy is effective and safe and should be considered in patients with SABP.

关 键 词：内镜逆行性胰胆管造影术 重症胆源性胰腺炎 META分析 系统评价 随机对照试验 

分 类 号：R576[医药卫生—消化系统]