内镜治疗急性胆源性胰腺炎的系统评价

Endoscopic treatment of acute biliary pancreatitis:a systematic review

目的:评价内镜治疗急性胆源性胰腺炎的临床疗效和安全性.方法:通过计算机检索全面收集全世界关于内镜治疗急性胆源性胰腺炎的随机对照试验/或半随机对照试验,并辅手工检索和其他检索.按照纳入排除标准纳入文献,由两名研究者独立筛选并提取资料,采用Hand book 5.0推荐的质量评价标准评价纳入研究的方法学质量,采用Rev Man5.0软件进行统计学处理.结果:最终纳入4个研究,包括317例患者.Meta分析结果显示内镜组治疗组与传统治疗组相比,在腹痛缓解时间(OR=-2.98,95%CI:-4.98,0.97)、白细胞复常时间(OR=-4.63,95%CI:-5.29,-3.97)、血淀粉酶复常时间(OR=-3.85,95%CI:-4.49,-3.21)、并发症发生率(OR=0.34,95%CI:0.18,0.66)和住院时间(OR=-7.51,95%CI:-9.89,-5.13)方面存在统计学差异.结论:当前研究显示,与传统治疗组相比,内镜治疗组能显著减少急性胆源性胰腺炎的腹痛缓解时间、白细胞及血淀粉酶复常时间,降低并发症的发生,缩短住院时间.

AIM： To assess the efficacy and safety of endoscopic treatment of acute biliary pancreatitis （ABP）.METHODS： Relevant databases were searched to identify randomized controlled trials or quasirandomized controlled trials evaluating the efficacy and safety of endoscopic treatment of acute biliary pancreatitis. The quality of the included studies was evaluated using the criteria recommended by the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0. Statistical analyses were performed with RevMan5.0 （Cochrane Collaboration） software.RESULTS： Four randomized controlled trials or quais-randomized controlled trials involving 317 patients were included. A meta-analysis showed that there were significant differences, between endoscopic treatment group and conventional treatment group, in the time to onset of abdominal pain relief [odd ratio （OR） = -2.98; 95% confidence interval （CI）： -4.98, -0.97], the time to recovery of white blood cells （OR = -4.63, 95%CI： -5.29, -3.97） and serum amylase （OR = -3.85; 95%CI： -4.49, -3.21）, the complication rate （OR = 0.34; 95%CI： 0.18, 0.66）, and the hospitalization time （OR = -7.51; 95%CI： -9.89, -5.13）.CONCLUSION： Current evidence shows that endoscopic treatment of acute biliary pancreatitis can significantly reduce the time to onset of abdominal pain relief, the time to recovery of white blood cells and serum amylase, the complication rate, and the hospitalization time.