PAIR与腹腔镜治疗肝囊型包虫病的系统分析

Comparison of PAIR and laparoscopic therapy for hepatic cystic echinococcosis:a systematic review

目的:通过对既往5年内研究进行系统分析,评价2种微创治疗——PAIR(穿刺、抽吸、注入和再抽吸)技术和腹腔镜技术对肝囊型包虫病的临床安全性和有效性。方法:通过检索Medline、Embase、Web of science、Cochrane Library数据库2014～2018年5年内的临床研究,共10篇文献最终纳入本研究,其中4篇主要讨论PAIR治疗肝囊型包虫病的疗效,5篇文献主要讨论腹腔镜治疗肝囊型包虫病的疗效,1篇既有腹腔镜治疗,也有PAIR治疗,主要效应指标为治愈率、复发率、术后并发症。结果:汇总分析结果示腹腔镜手术治愈率为98.65%,PAIR治愈率为98.31%,两者差异无统计学意义(P>0.05)。对于肝囊型包虫病,2种治疗方法均有效(P=0.780)。在治疗后复发率方面,腹腔镜治疗复发率1.14%,PAIR治疗复发率0.42%,差异无统计学意义(P=0.210)。2种治疗方式均无死亡病例,而安全性方面,腹腔镜治疗后胆道瘘、囊腔感染发生率显著高于PAIR(8.78%比0.64%,P<0.001;3.72%比1.06%,P=0.018),过敏反应发生率显著低于PAIR(0比2.54%,P=0.005)。结论:对肝囊型包虫病外科治疗而言,PAIR技术和腹腔镜治疗是安全和有效的。2种微创治疗具有不同的术后并发症特点,腹腔镜治疗胆道瘘和感染更常见,PAIR患者则过敏反应多见。

Obcertive:This paper updates the systematic analysis of research over the past 5 years.Systematical evaluation of the safety andefficacy for these two minimally invasive therapy.Methods:Publications during 2014-2018 were searched in Medline,Embase,Web of science,Cochrane Library through Mesh items combined with keywords and free term.10 publications were included at last.Among them,4 articles mainly discuss the efficacy of PAIR in the treatment of hepatic cystic echinococcosis.Five articles mainly discuss the efficacy of laparoscopic treatment of hepatic cystic echinococcosis,one with laparoscopic treatment and PAIR treatment.Primary outcomes include curative rates,recurrence rates,rates of postoperative complications.Results:Clinical and parasitological cure occurred in 98.65% patients receiving PAIR treatment and in 98.31% patients receiving laparoscopic therapy,the difference is not significant(P=0.780).As to recurrence rates,recurrence occurred in 1.14% patients receiving laparoscopic therapy and in 0.425% patients receiving PAIR treatment(P=0.210).No patients died of hepatic cystic echinococcosis.With regard to postoperative complications,compared to patients receiving PAIR treatment,biliary fistula and cyst infection occurred more in patients receiving laparoscopic therapy(8.78% vs 0.64%,P<0.001;3.72% vs 1.06%,P=0.018),allergic reaction occurred less in patients receiving laparoscopic therapy(0 vs 2.54%,P=0.005).Conclusion:For the treatment of hepatic CE,PAIR and laparoscopic therapy can be consided as the safe and effective approaches.They showed different characteristics of postoperative complications,biliary leakage and infections for laparocopy,meanwhile the more common in allergic and fever for PAIR.