腹腔镜Heller手术治疗贲门失弛缓症疗效和安全性的Meta分析  

Efficacy and Safety of Laparoscopic Heller's Myotomy in the Treatment of Achalasia:A Meta-analysis

作　　者：魏宁[1] 胡文滕 蔡谦谦 蔺瑞江 张瑜[1] 马敏杰[1] 韩彪[1] 

机构地区：[1]兰州大学第一医院胸外科,兰州730000 [2]兰州大学第一医院心外科,兰州730000

出　　处：《中国循证医学杂志》2016年第5期573-578,共6页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金(面上项目)(编号:31471953);甘肃省自然科学基金(编号:1208RJZA137、096RJZA080)

摘　　要：目的系统评价腹腔镜Heller手术与内镜下球囊扩张术治疗贲门失弛缓症的临床安全性和疗效。方法计算机检索PubMed、EMbase、The Cochrane Library（2015年8期）、Web of Knowledge、CBM、CNKI、VIP和WanFang Data,搜集腹腔镜Heller手术与内镜下球囊扩张术治疗贲门失弛缓症的相关随机对照试验（RCT）,检索时限均为从建库至2015年8月26日。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入5个RCT,包括446例患者。Meta分析结果显示：与内镜下球囊扩张术治疗贲门失弛缓症相比,腹腔镜Heller手术可提高治疗后3个月有效率[OR=2.66,95%CI（1.08,6.60）,P=0.03]和1年有效率[OR=2.24,95%CI（1.29,3.87）,P=0.004],但在治疗后2~3年有效率[OR=1.749,95%CI（0.99,3.23）,P=0.05]和并发症发生率[OR=0.27,95%CI（0.06,1.13）,P=0.07]方面,二者差异无统计学意义。结论现有证据表明,与内镜下球囊扩张术相比,腹腔镜Heller手术治疗贲门失弛缓症可以提高治疗后短期（3个月及1年）有效率,但两种治疗方式在治疗2年以上的有效率及并发症发生率方面无显著差异。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。Objective To systematically review the efficacy and safety of laparoscopic Heller＇s myotomy （LHM） versus pneumatic dilatation （PD） for achalasia. Methods Databases including PubMed, EMbase, The Cochrane Library （Issue 8, 2015）, Web of Knowledge, CNKI, CBM, WanFang Data and VIP were searched from inception to August 26th 2015, to collect randomized controlled trials （RCTs） of LHM versus PD for achalasia. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 5 RCTs involving 446 patients were included. The results ofmeta-analysis showed that, compared with PD, LHM could significantly improve the effective rates after 3-month and 1-year follow- up （OR=2.66, 95%CI 1.08 to 6.60, P=0.03; OR=2.24, 95%CI 1.29 to 3.87, P=0.004）. There were no statistical differences between the two groups in effective rate after more than 2-year follow-up （OR=1.749, 95%CI 0.99 to 3.23, P=0.05） and incidence of complications （OR=0.27, 95%CI 0.06 to 1.13, P=0.07）. Conclusions Current evidence shows that, compared with PD, LHM could improve the short-term effective rate but could not improve the long-term （2-3 years） effective rate and reduce the incidence of complications. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

关 键 词：贲门失弛缓症 腹腔镜Heller手术 系统评价 META分析 随机对照试验 

分 类 号：R655.4[医药卫生—外科学]