生长抑素治疗术后早期炎性肠梗阻疗效的Meta分析

Somatostatin for early postoperative inflammatory small bowel obstruction: A meta analysis of efficacy

目的术后早期炎性肠梗阻(EPISBO)是术后肠梗阻的一种特殊表现形式,也是腹部术后常见并发症之一;一般采用保守治疗,近年来,研究者在常规保守治疗的基础上结合生长抑素治疗EPISBO,疗效显著,但对其疗效缺乏客观性的系统评价。目的系统评价生长抑素用于治疗术后早期炎性肠梗阻(EPISBO)的临床疗效。方法计算机检索Cochrane Library、Embase、Pub Med、SCI、CBM、维普数据库,万方数据库,中国知网数据库,检索查找常规治疗与生长抑素结合常规治疗用于EPISBO患者的(RCT)随机对照试验,对纳入的研究进行方法学质量评价并提取相关数据,用Cochrane协作网提供的Revman5.3软件对数据进行Meta分析,并系统评价统计出来的结果。结果本研究共纳入10个RCT临床研究,共计639例研究对象。Meta分析结果显示:生长抑素+常规治疗在下列方面优于常规治疗,且具有统计学意义:(1)腹痛腹胀缓解时间:SMD=-0.85,95%CI:(-1.13,-0.57);(2)腹痛腹胀消失时间:MD=-2.45,95%CI:(-3.24,-1.67);(3)肠鸣音恢复时间:MD=-1.94,95%CI:(-2.85,-1.03);(4)肛门恢复排气排便时间:SMD=-1.25,95%CI:(-1.43,-1.08);(5)无效率(包括中转手术)率:RR=0.20,95%CI:(0.11,0.34);(6)住院时间:MD=-4.43,95%CI:(-4.86,-4.00)。结论目前研究表明常规治疗+生长抑素治疗EPISBO的疗效明显优于常规治疗,但暂无国外相关研究文献,结果相对局限,且纳入样本量少、样本质量相对不高,为充分地证实其疗效,今后有必要在国内外开展更多相关的高质量临床RCT试验。

Objective To assess the efficacy of somatostatin for early postoperative inflammatory small bowel obstruction( EPISBO). Methods Cochrane Library,Embase,Pub Med,SCI,CBM,VIP,CNKI and WANGFANG database were searched to screen out randomized controlled trials of somatostatin combined with conventional treatment compare with conventional treatment for EPISBO.Do methodological quality assessment and extract the relevant data from the included studies. The data were analyzed by using Revman5. 3 software. Results Ten studies( 639 patients) were included. The results of meta analysis show a striking difference between the two groups( somatostatin combined with conventional treatment and conventional treatment) :( 1) time to remission of abdominal pain and distention: SMD =- 0. 85,95% CI:(- 1. 13,- 0. 57);( 2) symptom disappearance time of abdominal pain and distention: MD=- 2. 45,95% CI:(- 3. 24,- 1. 67);( 3) recovery time of bowel sounds: MD =- 1. 94,95% CI:(- 2. 85,- 1. 03);( 4) time? of anal exsufflation: SMD =- 1. 25,95% CI:(- 1. 43,- 1. 08);( 5) rate of ineffective treatment( including conversion to operation) :RR = 0. 20,95% CI:( 0. 11,0. 34);( 6) hospitalization stay: MD =- 4. 43,95% CI:(- 4. 86,- 4. 00). Conclusion These researchs show that somatostatin combined with conventional treatment is superior to conventional treatment for EPISBO. Yet,more high quality randomized controlled studies are needed in the future,at home and abroad.