水下与常规内镜下黏膜切除术治疗大肠息肉有效性及安全性的Meta分析

Underwater endoscopic mucosal resection and conventional endoscopic mucosal resection for colonic polyps: a Meta-analysis

摘要:

目的 比较常规内镜下黏膜切除术（CEMR）与水下内镜下黏膜切除术（UEMR）两种治疗方法在切除大肠息肉方面的有效性及安全性。方法 检索近5年（2016年1月－2021年1月）发表在PubMed、Embase、Cochrane Library、中国知网（CNKI）、中国生物医学文献数据库（CBM）及万方等数据库有关UEMR及CEMR治疗大肠息肉的对比研究，采用Review Manager 5.3.5软件对两种手术方式的整块切除率、治愈性切除率、复发率、不良事件发生率、术中出血、迟发性出血和穿孔等多个方面进行Meta分析。结果 共纳入10篇文献，涉及1 954名患者，2 351个息肉病变。其中，UEMR组1 151个，CEMR组1 200个。Meta分析的结果显示：与CEMR相比，UEMR在整块切除率（RR＾ = 1.10，P = 0.000）、治愈性切除率（RR＾ = 1.36，P = 0.000）及切除时间（MD = -8.06，P = 0.030）上更具优势，并有更低的术后复发率（RR＾ = 0.45，P = 0.000）、不良事件发生率（RR＾ = 0.69，P = 0.020）和术中出血率（RR＾ = 0.58，P = 0.003），但迟发性出血和穿孔方面，两者差异均无统计学意义（P > 0.05）。结论 UEMR是一种安全、有效并可以替代CEMR的技术方法，值得在临床推广应用。

Abstract:

Objective To compare the effectiveness and safety of underwater endoscopic mucosal resection (UEMR) and conventional endoscopic mucosal resection (CEMR) for colonic polyps.Methods We searched the PubMed, Embase, Cochrane Library, CNKI, CBM and Wanfang database in recent 5 years (from January 2016 to January 2021) studies comparing UEMR with CEMR for treatment of colonic polyps. Review Manager 5.3.5 software was used to carry out Meta-analysis on the en bloc resection rate, R0 resection rate, recurrence rate, overall incidence of adverse events, hemorrhage during operation, delayed bleeding and perforation of the two surgical methods.Results 10 studies were included, involving 1 954 patients and 2 351 polyps, including 1 151 in the UEMR group and 1 200 in the CEMR group. Meta-analysis showed that compared with CEMR, UEMR had a higher en bloc resection rate (RR＾ = 1.10, P = 0.000), a higher R0 resection rate (RR＾ = 1.36, P = 0.000), and a shorter operative time (MD = -8.06, P = 0.030) and lower recurrence rate (RR＾ = 0.45, P = 0.000). The overall incidence of adverse events rate (RR＾ = 0.69, P = 0.020) and the hemorrhage during operation rate (RR＾ = 0.58, P = 0.003) in the UEMR group were lower than those in the CEMR group. There were no statistical difference in the incidence of delayed bleeding and perforation between the two groups (P > 0.05).Conclusion In this Meta-analysis, we found that UEMR is a safe and effective alternative to CEMR and worthy of clinical application.