重症急性胰腺炎早期手术与延期手术治疗效果Meta分析

Effect of early surgical treatment versus delayed surgical treatment on patients with severe acute pancreatitis:a Meta- analysis

目的系统评价重症急性胰腺炎早期手术与延期手术治疗效果。方法检索CNKI数据库、万方数据库、中文科技期刊数据库（维普）、中国生物医学文献数据库，查询符合纳入和排除标准的文献，检索时间限为1990年至2013年，提取符合条件的文献的资料及质量评估后，采用RevMan4．2软件进行Meta分析。结果共有6项NRCT纳入本次研究，Meta分析结果显示：早期手术组病死率高于延期手术组病死率（RR=2．18，95％CI为1．04～4．57，P=O．04），早期手术组并发症率高于延期手术组（RR=3．47，95％Cf为1．79～6．74，P=0．0002），早期手术组治愈率也低于延期手术组（RR=0．46，95％CI为0．22～0．97，P=-0．04）。结论在临床上早期手术不应常规作为重症急性胰腺炎患者的首选治疗方式，应严格把握早期手术的适应证。

Objective To evaluate the effect of early surgical treatment versus delayed surgical treatment on patients with severe acute pancreatitis. Methods Original articles met with the inclusion and exclusion criteria, which published from 1990 to 2013, were searched in CNKI, WanFang database and CBM, then the data was extracted and a Meta-analysis was conducted using RevMan4.2 software. Results Six NRCTs were included in this analysis. Compared with the deferred surgery group, there was a higher mortality rate in early surgical group （RR=2.18, 95% CI of 1.04-4.57, P=0.04）, a higher complications rate （RR=3.47, 95% CI of 1.79-6.74, P=0.0002）, and a lower cure rate （RR=0.46, 95% CI of 0.22-0.97, P=0.04）. Conclusion The result of this metaanalysis suggests that early surgical treatment should not be selected routinely in patients with severe acute pancreatitis as the first choice treatment, and the indications for early surgery should be strictly controlled.