腹腔镜Heller肌切开术与内镜下气囊扩张比较治疗贲门失弛缓症的Meta分析  

Meta Analysis of Laparoscopic Heller Myotomy and Endoscopic Pneumatic Dilation in Treatment of Achalasia of the Cardia

作　　者：何继东[1] 朱毓江 刘莉[1] HE Ji-dong;ZHU Yu-jiang;LIU Li(Digestive System Department,Yan’an Second People’s Hospital,Ya’an,Sichuan Province,625000 China)

机构地区：[1]雅安市第二人民医院消化内科,四川雅安625000

出　　处：《系统医学》2017年第14期46-48,共3页Systems Medicine

摘　　要：目的系统评价腹腔镜Heller术与气囊扩张比较治疗贲门失弛缓症的疗效和安全性。方法计算机检索Cochrane图书馆RCT数据库、Pub Med、EMbase、CBM、VIP、和Wan Fang等数据库建库至2016年12月。收集全世界腹腔镜Heller术与气囊扩张比较治疗贲门失弛缓症的RCT。采用Rev Man 5.2软件进行Meta分析。结果纳入4个RCT(437例)患者。Meta分析显示:(1)总体症状缓解率:LHM优于PD(78.38%和68.52%,P=0.04)。(2)手术相关穿孔发生率:LHM优于PD(0.50%和4.63%,P=0.02);(3)长期总体症状缓解率(24个月)、胃食管反流发生率、术后LES压力改善,两组差异无统计学意义。结论目前的证据表明,LHM和PD均有较好的长期疗效,但LHM在疗效和安全性上更有优势,建议根据医疗水平和患者具体情况选择使用。Objective To systematically evaluate the curative effect and safety of laparoscopic heller myotomy and endoscopic pneumatic dilation in treatment of achalasia of the cardia.Methods The RCT database,PubMed,EMbase,CBM,VIP and WanFang in Cochrane library from the establishment of database to December 2016 were retrieved by computers,and the RCT of laparoscopic heller myotomy and endoscopic pneumatic dilation in treatment of achalasia of the cardia?in the whole world were collected for Meta analysis by the RevMan 5.2 software.Results 4 RCT(437 cases)were included,and the Meta analysis showed that①the total symptoms relief rate of LHM was better than that of PD(78.38%and 68.52%,P=0.04).②the incidence rate of operation correlative perforation of LHM was better than that of PD,(0.50%and 4.63%,P=0.02).③The differences in the long-term and total symptoms relief rate(24 months),incidence rate of gastro-oesophageal reflux and improvement rate of postoperative LES pressure were not statistically significant.Conclusion The existing evidence shows that the LHM and PD have a better long-term curative effect,but the curative effect and safety of LHM are more advantageous,and it is suggested to be used according to the medical level and specific situations of patients.

关 键 词：腹腔镜Heller术 气囊扩张治疗 贲门失弛缓症 系统评价 META-分析 

分 类 号：R573.7[医药卫生—消化系统]