生长抑素预防内镜下逆行胆胰管造影术后胰腺炎有效性的Meta分析  

Meta-analysis on the efficacy of somatostatin for preventing post endoscopic retrograde cholangiopancreatography pancreatitis

作　　者：邝学军[1] 彭钊[1] 王建钧[1] 何松[1] 刘力[1] 

机构地区：[1]湘南学院附属医院肝胆外科,湖南郴州423000

出　　处：《湘南学院学报（医学版）》2017年第1期13-17,共5页Journal of Xiangnan University（Medical Sciences）

摘　　要：目的系统评价生长抑素预防内镜下逆行胆胰管造影(ERCP)术后胰腺炎(PEP)的有效性,以期为临床用药提供循证医学证据。方法计算机检索Cochrane library、Pub Med、OVID、EBSCO、Embase、Web of Science数据库,收集关于生长抑素预防PEP有效性的前瞻性随机对照试验(RCT)研究。检索时限均为建库至2016年10月。按Cochrane系统评价员手册对纳入文献进行质量评价和数据提取,采用Review Manager 5.3软件进行Meta分析。结果共纳入15篇RCT研究文献(4 342例),其中生长抑素组2 224例,对照组2 118例。Meta分析结果显示,与对照组比较,生长抑素组PEP发生率明显低于对照组(RR=0.61,95%CI:0.42~0.90,P=0.01);亚组分析显示,大剂量静脉泵入组和单次静脉推注组患者PEP发生率低于对照组(RR=0.47,95%CI:0.33~0.67,P<0.0001;RR=0.28,95%CI:0.15~0.52,P<0.0001),小剂量静脉泵入组患者PEP发生率与对照组比较组间差异无统计学意义(RR=1.27,95%CI:0.90~1.77,P=0.17)。结论大剂量静脉泵入和单次静脉推注生长抑素可有效降低PEP发生率,而小剂量静脉泵入生长抑素无预防PEP的作用。Objective To evaluate the efficacy of somatostatin in preventing pancreatitis after endoscopic retrograde cholangiopancreatography（ ERCP）,provides medical evidence for clinical medication. Methods A standardized comprehensive literature search was performed by Cochrane library、Pub Med、OVID、EBSCO、Embase and Web of Science databases from the inception date to October 2016 and randomized controlled trials（ RCT） on the prevention of post-ERCP pancreatitis（ PEP） were collected in the study. According to Cochrane Reviewers’ Handbook criteria,the quality evaluation and data extraction of the included literature were subjected to Meta-analysis by Review Manager 5. 3 analysis software. Results A total of fifteen RCT studies and 4 342 patients were finally included after the screening. Among them,2 224 cases were somatostatin group and 2 118 cases were control group. The results of Meta-analysis indicated that compared with control group,somatostatin group could significantly decrease the incidence of PEP（ RR = 0. 61,95% CI： 0.42 ～ 0. 90,P = 0. 01）; The results of subgroup analysis showed that high-dose intravenous pumping and single bolus somatostatin injection could significantly decrease the incidence of PEP（ RR = 0. 47,95% CI： 0. 33～ 0. 67,P 〈 0. 0001; RR = 0. 28,95% CI： 0. 15 ～ 0. 52,P 〈 0. 0001）,however,low-dose intravenous somatostatin pumping was proved ineffective in reducing the incidence of PEP（ RR = 1. 27,95% CI： 0. 90 ～ 1.77,P = 0. 17）. Conclusion High-dose intravenous somatostatin pumping and single bolus somatostatin injection could prevent the incidence of PEP while low-dose intravenous somatostatin pumping produced no effect in reducing the incidence of PEP.

关 键 词：胆胰管造影术 内窥镜逆行 胰腺炎 生长抑素 META分析 

分 类 号：R657.5[医药卫生—外科学]