经口内镜下肌切开术和球囊扩张术治疗贲门失弛缓症有效性和安全性的Meta分析  

Efficacy and Safety of Peroral Endoscopic Myotomy vs Pneumatic Dilation for Esophageal Achalasia:A Meta-analysis

作　　者：向诗兵 李晓丽[2] XIANG Shibing;LI Xiaoli(Shanxi Medical University,Taiyuan 030001,China;Department of Gastroenterology,the First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学,太原030001 [2]山西医科大学第一医院消化科,太原030001

出　　处：《医学综述》2020年第14期2878-2885,共8页Medical Recapitulate

摘　　要：目的系统评价经口内镜下肌切开术(POEM)和球囊扩张术(PD)治疗贲门失弛缓症的有效性和安全性。方法以贲门失弛缓、经口内镜下肌切开术、球囊扩张术、POEM、PD、peroral endoscopic myotomy、pneumatic dilation、achalasia等为检索词,检索CNKI、万方数据库、PubMed、Embase、The Cochrane Library、Web of Science等数据库关于贲门失弛缓症治疗的相关研究。检索时间为建库至2019年5月,语言限定为中文和英文。再由2名评价员分别筛选文献和提取数据,并进行文献质量评价。采用RevMan 5.3软件进行Meta分析。结果共纳入11篇文献,包括3篇随机对照试验,8篇队列研究,共775例患者,POEM组403例,PD组372例。Meta分析显示:两组术后1个月临床有效率比较差异无统计学意义(P>0.05),而POEM组术后3、6、12个月的临床有效率高于PD组(OR=3.93,95%CI 1.59~9.75,P=0.003;OR=2.71,95%CI 1.28~5.74,P=0.009;OR=4.12,95%CI 2.41~7.03,P<0.00001)。两组术后1、3个月Eckardt评分比较差异无统计学意义(P>0.05),POEM组术后6、12个月Eckardt评分低于PD组(MD=-0.60,95%CI-1.05^-0.14,P=0.01;MD=-0.97,95%CI-1.20^-0.73,P<0.00001)。POEM组术后3、12个月的食管下括约肌压力低于PD组(MD=-3.01,95%CI-4.83^-1.19,P=0.001;MD=-23.48,95%CI-25.75^-21.20,P<0.00001),POEM组术后3个月的食管下括约肌松弛率高于PD组(MD=5.50,95%CI 4.02~6.98,P<0.00001),POEM组术后3个月的4 s整合松弛压低于PD组(MD=-3.86,95%CI-4.47^-3.24,P<0.00001)。POEM组手术时间、住院时间长于PD组(MD=38.85,95%CI 32.20~39.50,P<0.00001;MD=4.20,95%CI 3.50~4.89,P<0.00001)。两组并发症发生率比较差异无统计学意义(P>0.05),POEM组胃食管反流发生率高于PD组(OR=1.97,95%CI 1.07~3.63,P=0.03)。结论POEM在临床有效率、Eckardt评分以及食管下括约肌客观指标等的改善上具有更显著且长久稳定的优势,但是会增加胃食管反流的风险。PD则在具有相同安全性和短期疗效的情况下,具有更短的手术时间和住�Objective To analyze efficacy and safety of peroral endoscopic myotomy(POEM)and pneumatic dilation(PD)for esophageal achalasia.Methods With achalasia,peroral endoscopic myotomy(POEM),pneumatic dilation(PD)both in Chinese and English as the search terms,CNKI,Wanfang database,PubMed,Embase,The Cochrane Library,and Web of Science were searched for studies about the treatment of achalasia.The retrieval time was from the establishment of database to May 2019,and the retrieval languages were limited to Chinese and English.Then 2 evaluators independently screened the literature and extracted the data,and conducted literature quality evaluation.Meta-analysis was performed with RevMan 5.3 software.Results A total of 11 studies including 3 randomized controlled trial and 8 cohort studies,including 775 patients(403 patients in POEM group and 372 patients in PD group)were included.Meta-analysis showed that there was no significant difference in clinical effectiveness at 1 month postoperatively between the two groups(P>0.05),while the clinical effectiveness at 3,6,and 12 months after surgery was higher in the POEM group than in the PD group(OR=3.93,95%CI 1.59-9.75,P=0.003;OR=2.71,95%CI 1.28-5.74,P=0.009;OR=4.12,95%CI 2.41-7.03,P<0.00001).There was no significant difference in the Eckardt score between the two groups at 1 and 3 months after surgery(P>0.05).The Eckardt score at the 6 and 12 months after surgery in the POEM group was lower than that in the PD group(MD=-0.60,95%CI-1.05--0.14,P=0.01;MD=-0.97,95%CI-1.20--0.73,P<0.00001).The pressure of the lower esophageal sphincter at 3 and 12 months after operation in the POEM group was lower than that in the PD group(MD=-3.01,95%CI-4.83--1.19,P=0.001;MD=-23.48,95%CI-25.75--21.20,P<0.00001).At 3 months after operation,the rate of relaxation of the lower esophageal sphincter in the POEM group was higher than that in the PD group(MD=5.50,95%CI 4.02-6.98,P<0.00001),and the 4 s integrated relaxation pressure was lower than that in the PD group(MD=-3.86,95%CI-4.47--3.24,P<0.00001).The

关 键 词：贲门失驰缓症 经口内镜下肌切开术 球囊扩张术 META分析 

分 类 号：R571.2[医药卫生—消化系统]