内镜经胃方式对比外科方式治疗感染坏死性胰腺炎的Meta分析*

Endoscopic transgastric versus surgical approach in treatment of infected necrotizing pancreatitis: a meta-analysis*

摘要:

摘要：目的 比较内镜经胃方式（ETA）和外科方式（SA）在治疗感染坏死性胰腺炎（INP）中的有效性及安全性。方法 在Pubmed、Web of Science、Embase、Cochrane Library、中国生物医学文献数据库、中国知网数据库、万方数据库和维普数据库中检索2000年1月－2018年3月公开发表的有关ETA与SA治疗INP对比研究的所有中英文文献，对纳入的研究进行质量评价，采用Revman 5.3软件进行Meta分析。结果 经过文献筛选后2篇随机对照研究（RCT）和4篇回顾性队列研究（RCS）最终被纳入分析，共295名患者。Meta分析结果显示：ETA组治疗成功率（62/79，78.5%）与SA组治疗成功率（37/66，56.1%）比较，差异无统计学意义（OR=1.54，95%CI：0.65～3.65，P >0.05），但ETA降低了死亡率（OR=0.12，95%CI：0.03～0.42，P <0.05）、总并发症的发生率（OR=0.13，95%CI：0.06～0.29，P <0.05）、新发器官衰竭的发生率（OR=0.26，95%CI：0.12～0.54，P <0.05）、胰瘘发生率（OR=0.09，95%CI：0.03～0.28，P <0.05）及切口疝的发生率（OR=0.10，95%CI：0.01～0.85，P <0.05），并且缩短了住院时间（MD=-17.72，95%CI： -21.30～-14.13，P <0.05），而ETA并没有增加出血（OR=0.76，95%CI：0.36～1.61，P >0.05）和穿孔发生率（OR=0.56，95% CI：0.25～1.23，P >0.05）。结论 ETA治疗INP是安全可行的，而且具有死亡率、术后并发症率低和住院时间短等优势，有望成为治疗INP的首选方法。

Abstract:

Abstract: Objective A systematic review and Meta-analysis was conducted to compare the effectiveness and safety of Endoscopic transgastric (ETA) versus surgical approach (SA) in infected necrotising pancreatitis (INP). Methods Pubmed, Embas, Cochrane Library, Web of Science, CBM, CNKI, CQVIP and WanFang data were systematically searched for eligible studies that compared ETA with SA for INP. The search was limited to papers published from January 2000 to March 2018. Study selection was performed according to predefined criteria. the quality of included studies was evaluated , then the Meta-analysis was conducted using RevMan 5.3 software. Results Eventually, 2 RCTS and 4 retrospective cohort studies including a total of 295 patients were identified. The results of the Meta-analysis for ETA versus SA showed: There were no significant difference regarding the clinical resolution rate [(62/79, 78.5%) vs (37/66, 56.1%), P > 0.05]. The mortality (OR = 0.12, 95% CI: 0.03 ~ 0.42, P < 0.05), complication rate (OR = 0.13, 95% CI: 0.06 ~ 0.29, P < 0.05), new onset organ failure rate (OR = 0.26, 95%CI: 0.12 ~ 0.54, P < 0.05), postoperative pancreatic fistula rate (OR = 0.09, 95%CI: 0.03 ~ 0.28, P < 0.05) and incisional hernia rate (OR = 0.10, 95%CI: 0.01 ~ 0.85, P < 0.05) were lower in the ETA group. Furthermore, there was a shorter hospital stay (MD = -17.72, 95% CI: -21.30 ~ -14.13, P < 0.05) in the ETA group. No differences were observed in terms of the postoperative bleeding (OR = 0.76, 95% CI: 0.36 ~ 1.61, P > 0.05) and perforation of a visceral organ (OR = 0.56, 95%CI: 0.25 ~ 1.23, P > 0.05). Conclusion ETA for the treatment of INP is safe and feasible with lower mortality, lower rate of postoperative complications and shorter hospital stay. ETA should be recommended as a preferred treatment for INP.