两种技术在ERCP选择性胆管插管困难时的系统评价和Meta分析  

Systematic Review and Meta-analysis of Two Techniques in Difficult Selective Bile Duct Intubation

作　　者：王立民 王良晶 王新 郭章允 Wang Limin;Wang Liangjing;Wang Xin(Qingdao University,Qingdao,Shandong,266000,China)

机构地区：[1]青岛大学,山东青岛266000 [2]成武县人民医院消化内科,山东成武274200 [3]苏州科技城医院消化内科,江苏苏州215153 [4]成武县人民医院普外科,山东成武274200

出　　处：《黑龙江医学》2024年第14期1789-1792,F0003,共5页Heilongjiang Medical Journal

基　　金：山东省医药卫生科技发展计划项目(202103030396)。

摘　　要：目的:系统评价胰管预切开技术(TPS)和双导丝技术(DGT)在经内镜逆行胰胆管造影术(ERCP)困难胆道插管中的有效性和安全性。方法:根据纳入和排除标准,由2位研究者使用计算机检索中国知网、万方、维普、PubMed、OVID、Medline和Cochrane数据库,提取关于两种技术在ERCP选择性胆管插管困难时的插管成功率、成功插管时间、术后并发症及胰腺炎的数据,应用RevMan 5.4软件进行Meta分析。结果:纳入12篇文献随机对照研究,共1033例患者。Meta分析结果显示,在ERCP选择性胆管插管困难时,使用TPS具有更高的胆管插管成功率,差异有统计学意义[RR=1.13,95%CI(1.03,1.24),P=0.01];在成功插管时间、术后总体并发症及ERCP术后胰腺炎方面,差异无统计学意义(P>0.05)。结论:TPS和DGT在选择性胆管插管困难时是两种非常有用的技术,相对于DGT而言,应用TPS有更高的插管成功率。Objective:To conduct a systematic review and meta-analysis to evaluate the effectiveness and security of both double guidewire(DGT)and transpancreatic sphincterotomy techniques(TPS)in difficult biliary cannulation.Methods:Based on inclusion and exclusion criteria,CNKI,VIP,WanFang,PubMed,OVID,Medline and Cochrane were retrieved by two researchers in order to extract the Successful incubation time,overall complications and ERCP postoperative pancreatitis.Using RevMan 5.4 for meta analysis.Results:12 studies were selected.These studies included 1033 patients.TPS had a significantly higher cannulation success rate when selective bile duct intubation was difficult,and the difference was statistically significant[RR=1.13,95%CI(1.03,1.24),P=0.01].There was no statistically significant difference in successful intubation time,overall complications and ERCP postoperative pancreatitis(P>0.05).Conclusion:TPS and DGT are two useful techniques in patients with difficult cannulation.TPS have a higher cannulation success rate compared to DGT.

关 键 词：胰管预切开技术 双导丝技术 经内镜逆行胰胆管造影术 META分析 

分 类 号：R615[医药卫生—外科学]