连续腹腔灌洗治疗重度急性胰腺炎的系统评价

Continuous Peritoneal Lavage for Severe Acute Pancreatitis:A Systematic Review

目的评价连续性腹腔灌洗治疗重度急性胰腺炎(SAP)的有效性及安全性。方法计算机检索Medline、Embase、Central、CBM、万方、CNKI和VIP数据库,以死亡率为主要结局指标,以并发症发生率、中转手术率、住院时间和住院费用作为次要结局指标。结果共纳入17篇随机对照研究,包括962位受试对象。Meta分析结果显示,腹腔灌洗能显著降低SAP的病死率[RR=0.45,95%CI(0.33,0.63),P<0.01],各研究间无统计学异质性(I2=8%,P=0.37)。对于其他次要结局指标,腹腔灌洗组与常规治疗组比较,差别有统计学意义(P均<0.05)。结论连续性腹腔灌洗对SAP患者可产生有利影响,但由于纳入文献的方法学质量较低,本系统评价的结论还有待进一步证实。

Objective To assess the efficacy and safety of peritoneal lavage in patients with severe acute pancreatitis. Methods A comprehensive search was performed to identify randomized controlled trials comparing peritoneal lavage with conservative treatment for severe acute pancreatitis. The primary endpoint was all-cause mortality,while the secondary endpoints included complications rate,proportion of need for operation,length of hospital stay,and medical costs. Results A total of 962 patients from seventeen studies were subjected to meta-analysis. Peritoneal lavage did significantly decrease the mortality（Relative risk,0.45;95%confidence interval,0.33-0.63;P〈0.01）,with low heterogeneity among the studies（I^2=8%,P=0.37）. Peritoneal lavage also appeared to significantly alter those other meta-analysis endpoints. Conclusions This analysis suggests that peritoneal lavage show robustly beneficial effect in patients with severe acute pancreatitis. However,the results of this analysis should be interpreted with caution due to the general high risk of bias in these trials.