球囊扩张和Heller肌切开治疗儿童贲门失弛缓症疗效和安全性的Meta分析

Efficacy and safety of balloon dilation vs.Heller myotomy for achalasia in children:a meta-analysis

目的采用Meta分析方法评价球囊扩张(BD)和Heller肌切开(HM)治疗儿童贲门失弛缓症的有效性和安全性。方法检索PubMed、EMBASE、Cochrane图书馆、中国生物医学文献数据库、维普全文数据库和万方生物医学期刊数据库。检索的时间均从建库至2012年5月。获得BD和HM治疗儿童贲门失弛缓症的对照研究。由2名作者进行资料提取和文献质量评价。应用RevMan5.0软件进行Meta分析,根据异质性结果选择相应的效应模型分析;无法进行Meta分析时采用描述性分析。结果8篇文献进入Meta分析,均为非随机分组的对照研究。8篇文献均报道了两组的复发率和并发症发生率。BD组与HM组治疗儿童贲门失弛缓症复发率的差异有统计学意义(OR=4.07,95%CI:1.41～11.69,P=0.009);两组并发症发生率的差异有统计学意义(OR=0.37,95%CI:0.15～0.90,P=0.03)。结论 HM治疗儿童贲门失弛缓症的复发率低于BD,并发症的发生率高于BD。因纳入文献质量较弱且样本量不大,明确结论仍需进一步研究。

Objective To undertake a systematic review to compare the efficacy and safety of balloon dilation（BD） with Heller myotomy（HM） in the treatment of achalasia in children.Methods Databases,including PubMed,EMBASE,Cochrane Library Database,CBMDisc,CMJD and Wanfang data,were searched to identify studies comparing BD and HM for achalasia in children from database establishment to May 2012.The key words were ＂achalasia＂ and ＂children＂.Two reviewers assessed the quality and extracted data.Software RevMan 5.0 was used to perform meta analysis.Heterogeneity of the included studies was tested to select a proper effect model.Results Eight retrospective studies were included to assess the recurrence rate and complication rate.The recurrence rate was lower in HM group than that in BD group（OR=4.07,95%CI：1.41-11.69,P=0.009）,but the complication rate was lower in BD group than that in HM group（OR=0.37,95%CI：0.15-0.90,P=0.03）. Conclusions The recurrence rate was lower in HM group than in BD group but the complication rate was lower in BD group than in HM group.Regarding the low level of study quality and small sample size of the recruited studies,these results need to be confirmed by further randomized controlled studies.