钛夹预防结直肠息肉切除术后不良事件疗效的Meta分析  

Effect of prophylactic clipping on adverse events after colorectal endoscopic resection:A metaanalysis

作　　者：高利英 刘希樵 黄宣[1] Li-Ying Gao;Xi-Qiao Liu;Xuan Huang(Department of Gastroenterology,the First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310002,Zhejiang Province,China)

机构地区：[1]浙江中医药大学附属第一医院消化内科,浙江省杭州市310002

出　　处：《世界华人消化杂志》2020年第15期710-718,共9页World Chinese Journal of Digestology

摘　　要：背景钛夹预防性夹闭创面对结直肠息肉切除术后迟发性出血及穿孔等不良事件的作用尚不明确,目前关于钛夹预防作用的有效性尚未达成共识.目的评价钛夹对预防结直肠息肉内镜下切除术后不良事件的疗效.方法计算机检索PubMed､EMBASE､Cochrane library､万方中关于结直肠息肉术中是否使用钛夹预防术后不良事件的研究,评价纳入研究质量,并用Revman 5.3软件进行统计学分析.结果共有7项RCT纳入标准,共计3777例患者,1880例患者术中使用钛夹预防性夹闭创面(钛夹组),1897例患者术中不使用钛夹夹闭创面(非钛夹组).Meta分析结果显示:钛夹组较非钛夹组的术后迟发性出血率低,差异具有统计学意义(2.55%vs 4.48%,P=0.01,95%CI:0.40-0.80);而钛夹组较非钛夹组的术后穿孔率无明显差异(0.66%vs 1.04%,P=0.42,95%CI:0.21-1.92).亚组分析显示,钛夹对预防结直肠息肉术后出血的作用,主要体现在大小≥20 mm的息肉上,对<20 mm息肉的预防效果不佳(RR=1.18,95%CI:0.62-2.23,P=0.62;RR=0.47,95%CI:0.29-0.77,P=0.003);钛夹对近端结肠息肉与远端结肠息肉切除术后的预防迟发性出血作用无明显差异(RR=0.57,95%CI:0.18-1.80,P=0.34;RR=0.78,95%CI:0.06-10.33,P=0.85).结论钛夹可预防结直肠息肉切除术后迟发性出血的发生,且主要体现在≥20 mm的病变中,此外钛夹对术后穿孔的预防作用不大.BACKGROUND The effect of prophylactic hemoclip placement on the risk of adverse events such as delayed bleeding and perforation after colorectal polypectomy is still unclear.Its efficiency has not been confirmed and there is no consensus on the usefulness of prophylactic clipping.AIM To assess the efficacy of prophylactic clipping on adverse events after endoscopic resection of colorectal polyps.METHODS We performed a search of PubMed,EMBASE,Cochrane library,and Wanfang databases for studies comparing the effect of clipping vs no clipping on adverse events following endoscopic resection.The quality of the included studies was performed.Statistical analysis was performed using Revman5.3 software.RESULTS We identified seven eligible randomized trials from the database search,involving a total of 3777 patients,which included 1880 patients who used prophylactic hemoclips(clip group)and 1897 who did not use(no clip group).Meta-analysis results showed that the delayed bleeding rate of the clip group was significantly lower than that of the no clip group(2.55%vs 4.48%,P=0.01,95%CI:0.40-0.80).There was no significant difference in postoperative perforation rate between the clip group and no clip group(0.66%vs 1.04%,P=0.42,95%CI:0.21-1.92).Subgroup analysis showed that the prophylactic effect on delayed bleeding was mainly observed in polyps with a size of≥20 mm,and the preventive effect in polyps less than 20 mm was poor(RR=1.18,95%CI:0.62-2.23,P=0.62;RR=0.47,95%CI:0.29-0.77,P=0.003).There was no significant difference in the effect of prophylactic hemoclips on the prevention of delayed bleeding after resection of proximal and distal colonic polyps(RR=0.57,95%CI:0.18-1.80,P=0.34;RR=0.78,95%CI:0.06-10.33,P=0.85).CONCLUSION Prophylactic hemoclips can prevent the occurrence of delayed bleeding after colorectal polypectomy,which is mainly observed in the lesions≥20 mm.In addition,hemoclips have little preventive effect on postoperative perforation.

关 键 词：钛夹 迟发性出血 内镜下黏膜切除术 内镜黏膜下剥离术 

分 类 号：R657.1[医药卫生—外科学] R656.9[医药卫生—临床医学]