内镜介入和外科手术治疗慢性胰腺炎疗效的荟萃分析  

Clinical effectiveness of endoscopic versus surgical treatment of chronic pancreatitis:a meta-analysis

作　　者：张楚悦 梁光进 苏莹珍 汪春峰 曾汪 曹凡 黄波 Zhang Chuyue;Liang Guangjin;Su Yingzhen;Wang Chunfeng;Zeng Wang;Cao Fan;Huang Bo(Department of Hepatobiliary and Pancreatic Surgery,the 920th Hospital of Joint Logistics Support Force,PLA,Kunming 650032,China;Department of Public Health,School of Medicine,Kunming University,Kunming 650214,China;Department of General Surgery,the Third People's Hospital of Kunming,Kunming 650200,China;Department of North City Surgery,Qujing First People's Hospital,Qujing 655000,China)

机构地区：[1]中国人民解放军联勤保障部队第九二〇医院肝胆胰外科,昆明650032 [2]昆明学院医学院公共卫生教研室,昆明650214 [3]昆明市第三人民医院普通外科,昆明650200 [4]曲靖市第一人民医院北城外科,曲靖655000

出　　处：《中华肝胆外科杂志》2023年第1期54-59,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：云南省科技厅科技计划(202001BA070001-191);云南省教育厅科学研究基金(2019J0567)。

摘　　要：目的比较内镜介入与外科手术治疗慢性胰腺炎(CP)的疗效。方法计算机检索中国知网、中国生物医学文献数据库、万方数据库、PubMed、Cochrane Library、Embase、Web of Science等数据库,检索建库至2022年8月14日比较内镜介入和外科手术治疗CP的文献。主要指标为疼痛缓解、临床症状缓解、术后并发症、新发内分泌功能不全、新发外分泌功能不全、住院时间、手术次数。采用Review Manager 5.4.1软件处理数据,计算合并的优势比(OR)或加权均数差(WMD)及其95%可信区间(95%CI)。结果共纳入7篇研究(3篇随机对照试验,4篇分析性研究)共708例CP患者,其中男性513例,女性195例。708例患者中364例接受内镜介入治疗,344例接受外科手术治疗。荟萃分析结果显示,外科手术组术后疼痛的总缓解率(OR=0.38,95%CI:0.24~0.59)、疼痛完全缓解率(OR=0.47,95%CI:0.29~0.77)、短期内(术后1~1.5年)疼痛缓解率(OR=0.42,95%CI:0.24~0.74)、临床症状缓解率(OR=0.23,95%CI:0.10~0.55)优于内镜介入组,并能减少手术次数(WMD=1.64,95%CI:0.89~2.40),差异均具有统计学意义(均P<0.05)。内镜介入组和外科手术组术后并发症、新发内分泌功能不全、新发外分泌功能不全和住院时间比较,差异均无统计学意义(均P>0.05)。结论外科手术在控制CP相关疼痛以及临床症状缓解方面优于内镜介入治疗,并且能有效减少手术次数。Objective To compare the efficacy of endoscopy and surgery in chronic pancreatitis.Methods CNKI,CBM,Wanfang,PubMed,Cochrane Library,Embase and Web of Science were searched to compared endoscopy and surgery for the clinical efficacy of chronic pancreatitis.Literatures were searched from the establishment of the database to August 14,2022.Compared pain relief,clinical response to initial treatment,complications,endocrine/exocrine insufficiency,length of hospital stay and mean number of procedures between the two groups.Manager 5.4.1 software was used for data analysis.Odds ratio(OR)or weighted mean difference(WMD)was calculated with 95%confidence interval(95%CI).Results A total of seven studies were included,including three randomized controlled trials and four retrospective studies with 708 patients.There were 513 males and 195 females.Endoscopic interventions were performed in 364 patients and 344 patients underwent surgery.The results of meta-analysis showed that the total pain relief rate(OR=0.38,95%CI:0.24-0.59)and the complete pain relief rate(OR=0.47,95%CI:0.29-0.77),short-term(1-1.5 years)pain relief rate(OR=0.42,95%CI:0.24-0.74),clinical relief rate(OR=0.23,95%CI:0.10-0.55)were better than the endoscopic group,and could significantly reduce the number of reoperation(WMD=1.64,95%CI:0.89-2.40),and the difference was statistically significant(all P<0.05).There were no significant differences in complications,new-onset endocrine insufficiency,new-onset exocrine insufficiency and length of hospital stay between the endoscopy group and the surgical group(all P>0.05).Conclusion Surgical intervention is superior to endoscopic treatment in controlling pain associated with chronic pancreatitis and in clinical relief after the first treatment,and can effectively reduce the number of reoperations.

关 键 词：胰腺炎 慢性 内窥镜检查 外科手术 荟萃分析 

分 类 号：R657.51[医药卫生—外科学]