胰管支架置入术预防内镜逆行胰胆管造影术后胰腺炎的系统评价

Pancreatic Duct Stenting for Preventing Post-ERCP Pancreatitis:A Systematic Review

目的 评价胰管支架置入术能否降低内镜逆行胰胆管造影 (endoscopicretryradecholangiopancre atograph ,ERCP)术后胰腺炎 (post ERCPpancredtitis ,PEP)高危患者PEP的发生率、严重程度及其临床应用的安全性。方法 计算机检索Cochrane上消化道和胰腺专业临床试验资料库 ( 2 0 0 4年第 1期 )、Cochrane临床对照试验资料库 ( 2 0 0 4年第 1期 )、MEDLINE( 196 6～ 2 0 0 4 4 )、EMBASE( 1985～ 2 0 0 4 4 )、中国生物医学文献数据库 ( 1970～ 2 0 0 4 4 )以及中国循证医学中心随机对照试验资料库 ,手工检索 8种相关中文期刊及所获文献的参考文献 ,全面收集全世界关于胰管支架置入术预防PEP的临床随机对照试验 ,并按Cochrane协作网推荐的方法进行系统评价。结果 共 6篇RCT包括 4 6 8例PEP高危患者被纳入评价。Meta分析结果显示 ,胰管支架置入术可降低PEP高危患者PEP的发生率 [PetoRR 0 31,95 %CI ( 0 19,0 5 2 ) ;P <0 0 0 0 0 1;NNT=6 ]及重度PEP的发生率 [PetoOR 0 13,95 %CI ( 0 0 4 ,0 4 7) ;P =0 0 0 2 ;NNT =2 4 ]。上述结果均与敏感性分析的结果一致。结论 胰管支架置入术可降低PEP高危患者PEP的发生率和重度PEP的发生率 ,可能是预防PEP的有效方法。

Objective To evaluate the effectiveness and safety of pancreatic duct stenting in prevention of post-ERCP (endoscopic retrograde cholangiopancreatography) pancreatitis for patients at high risk.Methods ST5'We searched the Controlled Trials Database of the Cochrane Upper Gastro-Intestinal and Pancreatic Disease Group (Issue 1, 2004), Cochrane Controlled Trials Register (Issue 1, 2004), MEDLINE (1966-2004, 4), EMBASE (1985-2004, 4), CBMdisk (1970-2004, 4), and the Chinese Cochrane Center Database of Clinical Trials; we handsearched 8 Chinese journals, and references of eligible studies were also screened for inclusion. Randomized controlled trials on pancreatic stent for preventing post-endoscopic restrograde cholangiopancreatography pancreatitis (PEP) were identified.The systematic review was conducted using methods recommended by the Cochrane Collaboration.Results B3Six trials involving 468 high-risk patients for post-ERCP pancreatitis were included. The incidence of post-ERCP pancreatitis was significantly reduced by pancreatic duct stenting \[Peto RR 0.31, 95% CI(0.19, 0.52); WTBXPWTB3<0.00001; NNT=6\]. The incidence of severe PEP was also significantly lower in pancreatic duct stenting group compared with the control group \[Peto OR 0.13, 95% CI(0.04,0.47); =0.002; NNT=24\]. The results were consistent with the sensitivity-analysis when abstracts were excluded. WT5'HZConclusion Pancreatic duct stenting appears to be an effective method to prevent PEP. Due to the limitation of the included trials and their methodology, the results should be considered with caution. High quality and large-scale trials are required.