早期内镜干预与保守治疗应用于急性重症胆源性胰腺炎疗效对比的Meta分析

Early endoscopic intervention versus conservative treatment in acute severe biliary pancreatitis: a Meta-analysis

摘要:

目的 比较早期内镜逆行胰胆管造影术（ERCP）±内镜下十二指肠乳头括约肌切开术（EST）和保守治疗应用于急性重症胆源性胰腺炎（ASBP）的有效性及安全性。方法 在Pubmed、Web of Science、Embase、Cochrane Library、中国知网数据库、万方数据库和维普数据库中检索有关比较早期内镜干预和保守方法治疗ASBP的随机对照研究（RCT），并使用RevMan 5.3软件分析数据。结果 纳入10篇RCT，共806例患者。Meta分析结果显示，与保守治疗相比，早期内镜干预能降低ASBP总并发症发生率（O = 0.58，95%CI：0.41～0.82，P = 0.002）、系统并发症发生率（O = 0.46，95%CI：0.32～0.67，P = 0.000）和胆管炎发生率（O = 0.11，95%CI：0.03～0.42，P = 0.001）；缩短患者腹痛持续时间（MD = -6.09，95%CI：-7.47～-4.70，P = 0.000）和住院时间（MD = -10.15，95%CI：-13.20～-7.09，P = 0.000）；但两组患者在死亡率、多器官功能障碍综合征（MODS）发生率、呼吸衰竭发生率、局部并发症发生率、假性囊肿发生率和胰腺脓肿/坏死发生率等方面比较，差异均无统计学意义（P > 0.05）。结论 早期内镜干预治疗ASBP是安全可行的，且具有降低并发症发生率、缓解腹痛及缩短住院时间等优势，有望成为治疗ASBP的首选方法。

Abstract:

Objective To compare the efficacy and safety of early endoscopic retrograde cholangiopancreatography (ERCP) ± endoscopic sphincterotomy (EST) and conservative treatment in treatment of acute severe biliary pancreatitis (ASBP).Methods We searched PubMed, web of science, Embase, Cochrane Library, CNKI database, Wanfang database and VIP database for randomized controlled trials (RCTs) related to early endoscopic intervention and conservative treatment for ASBP, and used RevMan 5.3 software for statistical analysis.Results 10 RCTs involving 806 patients were included. Meta analysis showed that compared with conservative treatment, early endoscopic intervention could reduce the incidence of total complications (O = 0.58, 95%CI: 0.41 ~ 0.82, P = 0.002), systematic complications (O = 0.46, 95%CI: 0.32 ~ 0.67, P = 0.000) and cholangitis (O = 0.11, 95%CI: 0.03 ~ 0.42, P = 0.001). The duration of abdominal pain (MD = -6.09, 95%CI: -7.47～-4.70, P = 0.000) and length of hospital stay (MD = -10.15, 95%CI: -13.20～-7.09, P = 0.000) were shortened. However, there were no significant difference in mortality, multiple organ dysfunction syndrome (MODS), respiratory failure, local complications, pseudocyst, pancreatic abscess/necrosis between the two groups (P > 0.05).Conclusion Early endoscopic intervention in treatment of ASBP is safe and feasible, and has the advantages of reducing the incidence of complications, relieving abdominal pain and shortening the length of hospital stay, which is expected to become the preferred method for the treatment of ASBP.