内镜下Oddi括约肌切开术中电流选择的综合分析  

Comprehensive analysis of the selection of electrosurgical current in endoscopic sphincterotomy

作　　者：段琼红[1] 卢明[1] 陈立模[2] 

机构地区：[1]华中科技大学同济医学院流行病与卫生统计学系,武汉430030 [2]华中科技大学同济医学院附属同济医院普外科

出　　处：《中华消化内镜杂志》2003年第5期314-317,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的 评价不同种类的电流对内镜下Oddi括约肌切开术(EST)并发症的影响,为临床合理选择EST。电流提供依据。方法 通过维普、万方、CNKI、MEDLINE等数据库及文献追溯的方法全面检索国内外已发表和未发表的相关文献。纳入标准为:对需要做EST的患者施行不同种类电流的随机对照临床试验(RCTs)。结果 在术后胰腺炎的发生上,单纯电流切割组(PC,243例)与混合电流切割组(BC,169例)的率差为-0.08,具有统计学意义(Z=2.73,P=0.006),而PC组与联合切割组(CC.129例)组的率差为-0.08,没有统计学意义(Z=1.91,P=0.06)。在术中出血发生上,PC组与BC组的率差为0.27,具有统计学意义(Z=5.94,P<0.001),而PC组与CC组的率差为0.18,具有统计学意义(Z=3.27,P=0.001)。结论 使用联合切割电流能有效地减少EST术中出血的发生,并且不会增加术后胰腺炎的风险。但该结论还需设计实施良好的多中心大样本的随机对照临床试验来证实。Objective To provide evidence for selecting electrosurgical current used in endoscopic sphincterotomy. Methods After a fully recursive literature searching for the published RCTs of different types of electrosurgical current in endoscopic sphincterotomy, we performed RCTs with different currents. Risk differences (RD) were calculated, together with their 95% confidence intervals (CI). Results After pooling, there were 243 patients in PC group, 169 in BC group, and 129 in CC group. For postsphincteroto-my pancreatitis, RD between PC Group and BC Group; PC Group and CC Group are -0. 08 (95% CI: [ -0.13, -0. 02, P= 0.006] and -0. 08 (95% CI: [ -0. 16, 0. 00] , P =0. 06) respectively. For bleeding during sphincterotomy, RD between PC Group and BC Group, PC Group and CC Group are 0. 27 (95% CI; [0.18,0.36], P<0.001) and 0. 18(95% CI: [0.07 ,0.28] , P =0.001) respectively. Conclusion Combo Cut (using pure cut current first then using blended cut current) decreased the rate of postsphincterotomy pancreatitis, and did not increase the rate of bleeding during sphincterotomy. But there is still a need to conduct multi-center RCTs to further prove it.

关 键 词：内镜 ODDI括约肌切开术 电流选择 并发症 出血 胰腺炎 

分 类 号：R657.4[医药卫生—外科学]