内镜逆行胰胆管造影术中不同胆管插管方式效果比较的Meta分析  

The efficiency of different biliary cannulation in endoscopic retrograde cholangiopancreatography： a meta-analysis

作　　者：马强[1] 姚亚东[1] 侯晓翔 王满才[1] 魏振刚[1] 田金徽[2] 张有成[1] 何晓东[1,2] 

机构地区：[1]兰州大学第二医院普通外科,730030 [2]兰州大学循证医学中心

出　　处：《中华内科杂志》2016年第11期863-868,共6页Chinese Journal of Internal Medicine

摘　　要：目的 采用Meta分析比较内镜逆行胰胆管造影（ERCP）术中两种插管方式（导丝辅助胆管插管与造影剂辅助胆管插管）对插管成功率和ERCP术后胰腺炎（PEP）的影响.方法 计算机检索国内外主要数据库,收集研究ERCP术中两种插管方式对插管成功率和PEP发生率影响的随机对照试验（RCT）.检索时间均为从建库至2015年1 1月,由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan5.2软件进行Meta分析.结果 最终纳入10个RCT,包括3 262例患者.Meta分析结果显示,与造影剂辅助胆管插管比较,导丝辅助胆管插管成功率更高（RR =1.04,95％CI 1.01 ～1.06,P＜0.01）,总PEP发生率更低（RR =0.54,95％ CI0.41～0.71,P＜0.01）,其中轻度PEP的发生率降低（RR =0.52,95％ CI0.36 ～0.73,P＜0.01）,而中度和重度PEP的发生率相当（RR =0.84,95％ CI0.43～1.64,P=0.61;RR =0.53,95％ CI0.22 ～ 1.31,P=0.17）.结论 与造影剂辅助胆管插管比较,导丝辅助胆管插管能提高插管成功率,降低总PEP发生率及轻度PEP发生率.Objective To compare the success rates of wire-guided biliary cannulation （WGC） and conventional cannulation （CC） and their effect on the outcome of post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP）.Methods All randomized controlled trials （RCTs） were collected by searching CNKI,WanFang Data,CBM,PubMed,Embase and Cochrane Library.The assessment of methodological quality and data extraction of the included studies were performed independently by two reviewers.Meta-analysis was conducted with RevMan 5.2 software.Results Ten RCTs,with a total of 3 262 patients enrolled,were retrieved.Meta-analysis demonstrated that WGC had a higher success rate （RR =1.04,95% CI 1.01-1.06,P 〈 0.01） and a lower risk of PEP after cannulation （RR =0.54,95% CI 0.41-0.71,P 〈 0.01）.The main reason for the lower risk of PEP was due to lower proportion of mild PEP patients after WGC（RR =0.52,95% CI 0.36-0.73,P 〈 0.01）,while the incidence of modest and severe PEP was comparable in the two groups （modest group：RR =0.84,95 % CI 0.43-1.64,P=0.61;severe group：RR=0.53,95%CI0.22-1.31,P=0.17）.Conclusion WGC may increase the success rate of cannulation and reduce the incidence of PEP because of less complications of mild PEP.

关 键 词：胰胆管造影术 内窥镜逆行 胰腺炎 随机对照试验 META分析 导丝 

分 类 号：R657.4[医药卫生—外科学]