内镜及外科“Step-up”在感染性胰腺坏死治疗中的Meta分析  

A Meta analysis on the comparison between endoscopic step-up approach and surgical step-up approach in the treatments of infected pancreatic necrosis

作　　者：敖先伟[1] 陈小银[1] 孔繁静[1] 周东兵[1] AO Xian-wei;CHEN Xiao-yin;KONG Fan-jing;ZHOU Dong-bing(Department of Gastroenterology,the Second Hospital of Jingzhou,4340oo Jingzhou,Hubei,China)

机构地区：[1]荆州市第二人民医院消化内科,湖北荆州434000

出　　处：《临床消化病杂志》2023年第5期403-409,共7页Chinese Journal of Clinical Gastroenterology

摘　　要：[目的]系统评价内镜“Step-up”与外科“Step-up”策略治疗感染性胰腺坏死(IPN)的临床疗效及安全性。[方法]通过检索知网(CNKI)、维普(VIP)、万方(Wanfang)、PubMed、the Cochrane library及Embase数据库中以内镜“Step-up”(内镜组)与外科“Step-up”(外科组)策略治疗IPN的临床随机对照试验(RCT)及临床回顾性队列研究(RCS)。运用Stata14.0软件对纳入文献进行Meta分析。[结果]共纳入10篇文献,3篇RCT,7篇RCS,总共510例研究对象,其中内镜组264例,外科组246例。Meta分析结果显示:内镜组与外科组在IPN治疗中对比,总有效率RR为1.06(0.89,1.26)、术后胰腺内分泌RR为0.60(0.36,1.02)及外分泌功能不全RR为0.97(0.76,1.23),差异无统计学意义(P>0.05);术后死亡率RR为0.46(0.28,0.74)、主要并发症RR为0.46(0.28,0.74)、新发脏器功能衰竭RR为0.31(0.19,0.52)、胰瘘RR为0.15(0.07,0.32)、腹腔内出血RR为0.40(0.24,0.67)、切口疝RR为0.16(0.03,0.87)、空腔脏器穿孔或瘘RR为0.46(0.27,0.80)、住院总时间SMD为-0.25(-0.48,-0.03),差异有统计学意义(P<0.05)。[结论]内镜“Step-up”与外科“Step-up”对IPN的治疗相比,具有类似的有效率,但前者具有相对较低的并发症及较短的住院时间。[Objective]To compare the clinical efficacy and safety of endoscopic step-up approach versus surgical step-up approach in the treatments of infected pancreatic necrosis.[Methods]Randomized Controlled Trials(RCT)or retrospective cohort study(RCS)on endoscopic step-up approach versus surgical step-up treatment in infected pancreatic necrosis were searched from the CNKI,VIP,Wanfang,PubMed,the Cochrane library and Embase database.The Stata14.0 software was used to analyze the recruited literatures.[Results]A total of 3 RCTs,7 RCSs literatures and 510 subjects were recruited.There were 264 in the endoscopic group and 246 in the surgical group.The Meta-analysis results showed that:compare to the surgical step-up approach,total efficiency RR in endoscopic step-up approach in the treatments of infected pancreatic necrosis was 1.06(0.89,1.26),postoperative pancreatic endocrine insufficiency RR was 0.60(0.36,1.02)and exocrine insufficiency RR was 0.97(0.76,1.23).The differences showed no statistical significance.The postoperative mortality rate by endoscopic step-up approach was 0.46(0.28,0.74),major complications RR was 0.46(0.28,0.74),and new organ failure RR was 0.31(0.19,0.52),pancreatic fistula RR was 0.15(0.07,0.32),intraabdominal bleeding RR was 0.40(0.24,0.67),incisional hernia RR is 0.16(0.03,0.87),enterocutaneous fistula or perforation was RR 0.46(0.27,0.80)and length of hospital stay SMD was-0.25(-0.48,-0.03).The differences were statistically significant(P<0.05).[Conclusion]Endoscopic step-up approach,as compared to surgical step-up approach,has a similar clinical resolution rate and significantly reduces complications in patients with infected necrotizing pancreatitis.

关 键 词：急性胰腺炎 感染性胰腺坏死 内镜 外科 META分析 

分 类 号：R576[医药卫生—消化系统]