内镜与手术治疗坏死性胰腺炎疗效和安全性的Meta分析  

Efficacy and safety of endoscopic vs surgical management of necrotizing pancreatitis:A meta-analysis

作　　者：周颖 高志强[1] 张学松[1] Ying Zhou;Zhi-Qiang Gao;Xue-Song Zhang(Department of Gastroenterology,Ningbo Medical Treatment Center Lihuili Hospital,Ningbo 315040,Zhejiang Province,China)

机构地区：[1]宁波市医疗中心李惠利医院消化内科,浙江省宁波市315040

出　　处：《世界华人消化杂志》2020年第8期285-295,共11页World Chinese Journal of Digestology

基　　金：浙江省医药卫生科技项目,No.2018KY705;宁波市自然基金,No.2018A610374.

摘　　要：背景消化内镜和外科手术是治疗坏死性胰腺炎的两种主要有创方式,但比较二者疗效和安全性的研究尚缺乏.目的系统评价消化内镜和外科手术治疗坏死性胰腺炎的疗效和安全性.方法检索PubMed、EMBASE、Cochrane Library、中国知网、万方和中国生物医学文献数据库2000-01/2019-06发表的比较内镜和手术治疗坏死性胰腺炎的随机对照研究(randomized control trials,RCT)和队列研究,使用Revman5.3软件进行数据分析.结果共纳入8篇文献,其中3篇为RCT,5篇为队列研究.患者总数366例,其中内镜组167例,手术组199例.Meta分析结果显示:内镜组和手术组在临床缓解率(OR=1.3,95%CI:0.58-2.92,P=0.52)、复合结局变量——主要并发症或死亡(RR=0.46,95%CI:0.17-1.27,P=0.14)和死亡率(OR=0.78,95%CI:0.37-1.56,P=0.52)上无统计学差异.术后并发症中,内镜组相比于手术组,新发器官衰竭(OR=0.40,95%CI:0.18-0.90,P=0.03)、肠皮瘘或消化道穿孔(OR=0.46,95%CI:0.23-0.91,P=0.02)、胰瘘(OR=0.09,95%CI:0.03-0.24,P<0.00001)的发生率显著降低;而两组间术后腹腔出血、胰腺内分泌和胰腺外分泌功能不全的发生率无统计学差异.结论内镜和手术治疗坏死性胰腺炎的疗效无显著差异,但内镜可显著降低术后并发症的发生率.BACKGROUND Endoscopy and surgery are the two major invasive interventions for necrotizing pancreatitis.However,studies comparing their efficacy and safety are lacking.AIM To systemically compare the efficacy and safety of endoscopic and surgical interventions for necrotizing pancreatitis.METHODS PubMed,EMBASE,Cochrane Library,CNKI,Wanfang database,and Sino Med were searched to identify all randomized control trials(RCT)and cohort studies comparing the efficacy and safety of endoscopic vs surgical management of necrotizing pancreatitis from January 2000 to June 2019.Revman 5.3 was used for statistical analysis.RESULTS A total of eight studies were included,with three RCT and five cohort studies.The total number of patients involved was 366,with 167 in the endoscopy group and 199 in the surgery group.Meta-analysis showed no significant difference between the two groups in clinical remission(odds ratio[OR]=1.3,95%confidence interval[CI]:0.58-2.92,P=0.52),primary composite endpoint(relative risk[RR]=0.46,95%CI:0.17-1.27,P=0.14),or mortality(OR=0.78,95%CI:0.37-1.56,P=0.52).Compared to surgery,endoscopic therapy significantly reduced the rates of postoperative complications including new-onset organ failure(OR=0.40,95%CI:0.18-0.90,P=0.03),enterocutaneous fistula or perforation of a visceral organ(OR=0.46,95%CI:0.23-0.91,P=0.02),and pancreatic fistula(OR=0.09,95%CI:0.03-0.24,P<0.00001).CONCLUSION Endoscopic treatment,as compared to surgery,significantly reduces complications in patients with necrotizing pancreatitis.

关 键 词：坏死性胰腺炎 内镜 手术 META分析 

分 类 号：R657.5[医药卫生—外科学]