内镜微创对比外科手术治疗胰腺假性囊肿的Meta分析

Meta-analysis of endoscopic minimally invasive versus surgical operation in the treatment of pancreatic pseudocysts

目的系统评价内镜微创、外科手术两种处理胰腺假性囊肿(PPC)方法的疗效。方法计算机检索Cochrane Library、Medline、Embase数据库,并进行手动检索,根据文献纳入和排除标准选取相关文献,在对纳入的研究进行质量评估和资料提取后,采用Chocrane协作网提供的Rev Man 5.3软件进行Meta分析。结果共纳入2篇随机对照实验和4篇病例对照研究,包括247例患者(内镜组141例,手术组136例)。Meta分析结果提示,两种方法的技术成功率均高且接近100%;内镜组的短期成功率低于外科手术组(RR=0.14,95%CI:0.05~0.36,P<0.0001);内镜组的长期成功率(RR=0.56,95%CI:0.22~1.42,P=0.22)、并发症发生率(RR=0.90,95%CI:0.44~1.82,P=0.77)、复发率(RR=0.52,95%CI:0.13~2.06,P=0.35)相较于手术组差异无统计学意义;内镜组的住院天数(SMD=-4.55,95%CI:-8.25^-0.84,P=0.02)、花费(SMD=-1.09,95%CI:-1.51^-0.68,P<0.000 01)少于手术组。结论推荐内镜治疗作为胰腺假性囊肿的首选治疗方法,若内镜治疗后囊肿持续存在或出现危急并发症等情况可转行外科手术治疗。

Objective To systematically evaluate the efficacy of the endoscopic minimally invasive versus surgical operation in the treatment of pancreatic pseudocysts. Methods Databases of Cochrane Library, Medline, Embase were electronically searched to collect related controlled clinical trials, and the relevant references of included papers were manually collected. The trails were screened according to the inclusion and exlution criteria, after assessing the methodology quality and extracting the data, Meta-analysis were performed by using the Cochrane Collaboration＇s RevMan 5.3 software. Results Two randomized controlled trials and four case-control studies were enrolled involving 247 patients （endoscopic group：141 patients, surgical group：136 patients）. The result of Meta-analysis showed that the technical success rate of the two methods were high, almost 100%. The short-term success rate of the endoscopic treatment was lower than that of the surgical treatment （RR = 0.14, 95%CI： 0.05-0.36, P 〈 0.0001）. There were no significant differences in long-term success rate （RR = 0.56, 95%CI： 0.22-1.42, P=0.22）, complication rate （RR = 0.90, 95%CI： 0.44-1.82, P=0.77） and recurrence rate （RR = 0.52, 95%CI： 0.13-2.06, P=0.35） between endoscopic treatment and surgical treatment. The length of stay （SMD=-4.55, 95%CI： -8.25- -0.84, P=0.02） and the total costs （SMD=-1.09, 95%CI： -1.51- -0.68, P〈0.000 01） of the endoscopic treatment were less than those of the surgical treatment. Conclusion Endoscopic therapy is recommended as the optimum method in pancreatic pseudocysts. In the condition of persistent cyst after endoscopic treatment or critical complications should turn to surgical treatment.