内镜下冷圈套器和热圈套器切除结直肠小息肉疗效和安全性研究的Meta分析

Meta-analysis on the efficacy and safety of cold and hot snare polypectomy for small colorectal polyps

摘要:

目的 评价采用冷圈套器或热圈套器切除结直肠小息肉（直径≤10 mm）的有效性和安全性，并进行Meta分析。方法 计算机检索2010年－2020年中国知网、维普和PubMed等数据库发表的关于比较冷圈套器和热圈套器切除结直肠小息肉疗效的临床研究，根据纳入和排除标准筛选文献。采用RevMan 5.3软件对符合纳入标准的文献进行Meta分析。观察指标包括：完整息肉切除率、息肉回收率、术后并发症和手术时间。结果 共纳入研究11篇，包括6 196例息肉。冷圈套器和热圈套器切除的完整息肉切除率比较，差异无统计学意义（91.96% vs 91.38%，P > 0.05，O = 0.79，95%CI：0.49～1.26）；息肉回收率比较，差异无统计学意义（97.63% vs 98.21%，P > 0.05，O = 0.91，95%CI：0.61～1.36）；术后并发症包括术后腹部不适、迟发性出血和穿孔，冷圈套器切除术（CSP）术后腹部不适发生率明显高于热圈套器切除术（HSP）（2.61% vs 0.34%，P < 0.05，O = 9.75，95%CI：1.16～82.11），HSP的穿孔率高于CSP（0.17% vs 0.00%），但两者比较，差异无统计学意义（P > 0.05，O = 0.21，95%CI：0.01～4.49）；HSP的迟发性出血率高于CSP（0.87% vs 0.08%，P < 0.05，O = 0.23，95%CI：0.07～0.80）；手术时间包括总操作时间和仅息肉切除时间，CSP的总操作时间（P < 0.05，MD = -7.44，95%CI：-9.29～-5.60）和仅息肉切除时间（P < 0.05，MD = -0.33，95%CI：-0.39～0.26）均短于HSP。结论 冷圈套器和热圈套器的息肉完整切除率和回收率比较，差异均无统计学意义；两种术式的穿孔率比较，差异亦无统计学意义；CSP术后腹部不适的发生率较HSP高，但迟发性出血率较低，且手术时间较短。建议切除≤ 10 mm的小息肉，优先选择CSP。

Abstract:

Objective To evaluate the efficacy and safety of cold snare polypectomy (CSP) and hot snare polypectomy (HSP) for small polyps, and conduct a meta analysis.Methods Randomized-controlled trials were reviewed to compare CSP with HSP for resecting small colorectal polyps from 2010 to 2020, the literature was selected according to inclusion and exclusion criteria. Meta-analysis was performed by RevMan 5.3 software. The outcomes reviewed include polyp complete resection rate, recovery rate of polyp, postoperative complications and procedure time.Results 11 studies were reviewed in this meta-analysis, including 6 196 polyps. There was no significant difference in complete polyps resection rate between the cold snares and hot snares (91.96% vs 91.38%, P > 0.05, O = 0.79, 95%CI: 0.49～1.26); There was no significant difference in recovery rate of polyp (97.63% vs 98.21%, P > 0.05, O = 0.91, 95%CI: 0.61～1.36). Postoperative complications include abdominal pain, delayed bleeding rate and perforation, the incidence of abdominal pain after CSP was higher than HSP (2.61% vs 0.34%, P < 0.05, O = 9.75, 95%CI: 1.16～82.11). The perforation rate of HSP was higher than CSP (0.17% vs 0.00%), but the difference was no statistically significant (P > 0.05, O = 0.21, 95%CI: 0.01～4.49)．The delayed bleeding rate of HSP was higher than CSP (0.87% vs 0.08%, P < 0.05, O = 0.23, 95%CI: 0.07～0.80). Procedure time includes total procedure time and polypectomy removal time. The total procedure time of HSP was longer than CSP (P < 0.05, MD = -7.44, 95%CI: -9.29～-5.60). The polypectomy removal time with HSP was longer than CSP (P < 0.05, MD = -0.33, 95%CI: -0.39～0.26).Conclusion The incidence of abdominal discomfort after CSP was higher than that of HSP, the rate of delayed bleeding in CSP was lower than HSP, and the operation time was shorter than HSP. There were no statistical difference in complete resection rate, polyp recovery rate and the incidence of perforation between the CSP and HSP. Therefore, we recommend CSP should be preferred as the method to remove small colorectal polyps ≤10 mm.