冷圈套治疗结直肠小息肉安全性和有效性的Meta分析

Effectiveness and safety of cold snare polypectomy for small colorectal polyps: a Meta-analysis

摘要:

目的 探讨冷圈套切除结直肠小息肉（ < 10 mm）的安全性和有效性。方法 检索Embase、PubMed、The Cochrane Library、中国知网和万方等数据库自建库开始至2020年3月冷圈套切除 ≤ 10 mm息肉的临床随机对照试验（RCT）。文献包含从息肉切除后创面边缘再次获得标本评估完整切除率，并报道了并发症的，则纳入Meta分析。按照Cochrane评分标准对纳入的文献进行质量评价，使用RevMan 5.3软件对数据进行统计学分析。结果 11项RCT共2 211例患者2 917枚息肉被纳入研究。结果表明，冷圈套息肉切除术（CSP）组与热圈套息肉切除术（HSP）组完整切除率比较，差异无统计学意义（93.9%和96.0%，O：0.62，95%CI：0.28～1.35，P > 0.05）；CSP组立即出血率较HSP组高（10.1%和3.2%，O：3.26，95%CI：1.36～7.82，P < 0.01）；CSP组特定息肉切除时间较HSP组短（MD：-21.73，95%CI：-38.72～-4.74，P < 0.05）；CSP组与HSP组延迟出血率、穿孔和标本回收率比较，差异均无统计学意义。CSP组完整切除率高于冷活检钳息肉切除术（CFP）组（93.9%和87.1%，O：2.23，95%CI：1.45～3.43，P < 0.01）；CSP组标本回收率较CFP组低（95.4%和100.0%，O：0.09，95%CI：0.02～0.34，P < 0.01）；CSP组与CFP组立即出血率、延迟出血率、穿孔和特定息肉切除时间比较，差异均无统计学意义。结论 冷圈套可作为切除 < 10 mm结直肠小息肉的首选技术之一。

Abstract:

Objective To investigate the safety and efficacy of cold snare for resection of small colorectal polyps ( < 10 mm).Methods From the establishment of the database to March 2020, Embase, PubMed, the Cochrane library, CNKI and WanFang were electronically searched for relevant randomized controlled trials of comparing CSP and HSP or cold forceps for remove ≤ 10 mm colorectal polyps were considered. Specimens were obtained from the wound edge after polypectomy to evaluate the complete resection rate, and those with complications reported were included in this study. The Cochrane risk of bias assessment tool was used to evaluate the methodological quality of the included studies, and the Meta quantitative analysis was carried out with RevMan 5.3 software.Results 11 RCT involving 2 211 patients and 2 917 polyps were analyzed. The results show that complete resection rate using CSP was similar to HSP (93.9% vs 96.0%, O: 0.62, 95% CI: 0.28~1.35, P > 0.05). The rate of immediate bleeding was higher in CSP group than that in HSP group (10.1% vs 3.2%, O: 3.26, 95%CI: 1.36~7.82, P < 0.01). specific polypectomy time in CSP group was shorter than that in HSP group (MD:-21.73, 95%CI: -38.72~-4.74, P < 0.05). There was no difference in delayed bleeding rate, perforation and polyp retrieval between CSP and HSP group. In addition, complete resection rate using CSP was significantly higher than cold forceps (93.9% vs 87.1%, O: 2.23, 95%CI: 1.45~3.43, P < 0.01). Polyp retrieval after CSP was lower than cold forceps (95.4% vs 100.0%, O: 0.09, 95% CI: 0.02~0.34, P < 0.01). There was no difference in immediate bleeding rate, delayed bleeding rate, perforation, specific polypectomy time between CSP and cold forceps group.Conclusion CSP can be used as one of the first choice techniques for resection of small colorectal polyps < 10 mm.