POEM与LHM在贲门失弛缓症治疗有效性和安全性的Meta分析  

Efficacy and safety of peroral esophageal myotomy vs laparoscopic Heller's myotomy for treatment of achalasia: A meta-analysis

作　　者：胡小军[1] 王根旺[2] 张龙龙[2] 钱彬彬[2] 顾越雷 李峰[2] 杨孙虎[2] Xiao-Jun Hu Gen-Wang Wang Long-Long Zhang Bin-Bin Qian Yue-Lei Gu Feng Li Sun-Hu Yang(Department of Hepatobiliary Surgery, the Fifth Affiliated Hospital of Southern Medical University, Guangzhou 510900, Guangdong Province, China Department of General Surgery, the Ninth Affiliated Hospital of Shanghai Jiaotong University, Shanghai 201999, China)

机构地区：[1]南方医科大学第五附属医院肝胆外科,广东省广州市510900 [2]上海交通大学医学院附属第九人民医院,上海市201999

出　　处：《世界华人消化杂志》2017年第9期792-802,共11页World Chinese Journal of Digestology

摘　　要：目的比较经口内镜下食管肌层切开术(per-oral endoscopic myotomy,POEM)与腹腔镜Heller肌切开术(laparoscopic Heller's myotomy,LHM)临床有效性和安全性,为贲门失弛缓症最佳治疗提供证据.方法检索PubMed、EMBASE、the Cochrane Library、SCI数据库、CNKI和维普中文科技期刊数据库,检索语言为中英文,检索时间为各数据库建库时间至2016-02-20截止.采用Review Manager version5.3软件进行数据分析.各研究间的异质性通过Q检验和I2来检验.结果总共有8篇非随机对照研究纳入统计分析,共574例患者,其中POEM组245例,LHM组329例.Meta分析结果显示:(1)临床有效率:相比LHM组,POEM组有更高的临床有效率(RR=1.14,95%CI:1.02-1.27,P=0.02),异质性检验P=0.60,I^2=0%;(2)主要并发症:POEM组和LHM组,两者在主要并发症上没有统计学差异(RR=1.16,95%CI:0.76-1.78,P=0.49),异质性检验P=0.43,I^2=0%;(3)全部并发症:两组间全部并发症没有显著的统计学差异(RR=0.99,95%CI:0.72-1.36,P=0.94],异质性检验P=0.12,I^2=39%;(4)住院时间:两组间住院时间没有统计学意义(MD=-0.46,95%CI:-1.09-0.16,P=0.14),异质性检验P=0.0007,I^2=76%;(5)手术时间:两组间手术时间没有统计学意义(MD=-35.45,95%CI:-87.01-16.10,P=0.18),异质性检验:P<0.00001,I^2=98%.结论 POEM优于LHM,但本文还无法明确POEM是否是贲门失弛缓症的最佳治疗方法 ,需要进一步验证.AIM To add convincing evidence to the best treatment of achalasia by comparing peroral esophageal myotomy（POEM） with laparoscopic Heller’s myotomy（LHM） with regard to clinical efficacy and safety.METHODS The databases including PubMed,EMBASE,the Cochrane Library,Web of Science,CNKI and China Science and Technology Journal Database were fully searched for relevant articles published in Chinese and English form database inception to February 20,2016.The data were analyzed using Review Manager version 5.3 software.To assess the variation across studies,heterogeneity was measured with the I^2 index and Q test.RESULTS Eight non-randomized comparative studies that included a total of 574 patients（245 in the POEM group and 329 in the LHM group）met our research criteria and were assessed.Meta-analysis results were showed as follows：（1） clinical effect：the POEM group had a better result than the LHM group（RR = 1.14,95%CI：1.02-1.27,P = 0.02） with high betweenstudy homogeneity（P = 0.60,I^2= 0%）;（2）major complications：There was no difference between the POEM group and LHM group（RR= 1.16,95%CI：0.76-1.78,P = 0.49） with high between-study homogeneity（P = 0.43,I^2 = 0%）;（3） all complications：No significant difference was detected between the POEM group and LHM group（RR = 0.99,95%CI：0.72-1.36,P =0.94）.Moderate heterogeneity existed among the included studies（P = 0.12,I^2 = 39%）;（4）length of hospital stay：There was no statistical difference between the two groups（MD =-0.46,95%CI：-1.09-0.16,P = 0.14） with high between-study heterogeneity（P = 0.0007,I2 =76%）;（5） operative time：The outcome showed no significant difference between the POEM group and LHM group（MD =-35.45,95%CI：-87.01-16.10,P = 0.18） with high heterogeneity（P 〈 0.00001,f= 98%）.CONCLUSION POEM is superior to LHM in terms of shortterm clinical efficacy.It is still inconclusive on whether POEM is the best therapy for achalasia or not.Long-time follow-up studies are needed to s

关 键 词：贲门失弛缓症 经口内镜下食管肌层切开术 腹腔镜Heller肌切开术 META分析 

分 类 号：R656.6[医药卫生—外科学]