冷圈套息肉切除术与热圈套息肉切除术治疗结直肠小息肉疗效比较的Meta分析

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

摘要:

目的 系统性评价冷圈套息肉切除术（CSP）与热圈套息肉切除术（HSP）治疗结直肠小息肉的有效性和安全性，并进行Meta分析。方法 检索PubMed、Embase、Cochrane Librabry、中国知网、万方数据和维普网等6个数据库，筛选研究CSP和HSP治疗结直肠息肉疗效的前瞻性随机对照试验（RCT）。采用RevMan 5.3统计软件进行分析，指标包括：息肉切除率、标本回收率、术后并发症和手术时间。结果 20项RCT纳入该研究，包含4 103例患者，6 890枚息肉。其中，CSP 3 452枚，HSP 3 438枚。CSP与HSP息肉完整切除率比较，差异无统计学意义（RR＾ = 1.00，95%CI：0.98～1.01，P = 0.596）；CSP与HSP整块切除率比较，差异无统计学意义（RR＾ = 0.98，95%CI：0.95～1.01，P = 0.222）。CSP与HSP标本回收率比较，差异无统计学意义（RR＾ = 1.00，95%CI：0.99～1.01，P = 0.824）。术后并发症（术中出血、迟发性出血及穿孔）：CSP术中出血风险高于HSP（RR＾ = 1.66，95%CI：1.24～2.24，P = 0.001），CSP迟发性出血风险低于HSP（RR＾ = 0.31，95%CI：0.16～0.63，P = 0.001），CSP与HSP穿孔发生率比较，差异无统计学意义（RR＾ = 0.33，95%CI：0.09～1.22，P = 0.097）。手术时间：CSP总操作时间短于HSP（MD = -7.15，95%CI：-8.25～-6.06，P = 0.000），CSP息肉切除时间短于HSP（MD = -1.86，95%CI：-2.85～-0.86，P = 0.000）。结论 CSP切除结直肠小息肉的疗效与HSP相当，但能降低迟发性出血发生率，缩短手术时间，值得在临床推广应用。

Abstract:

Objective To evaluate the efficacy and safety of cold snare polypectomy (CSP) versus hot snare polypectomy (HSP) for resecting small colorectal polyps, and conduct a Meta-analysis.Methods 6 databases including PubMed, Embase, Cochrane Librabry, CNKI, Wanfang data and VIP were searched, and prospective randomized controlled trials (RCT) about CSP vs HSP for resecting colorectal polyps were enrolled. RevMan 5.3 was used for Meta-analysis. Outcomes reviewed include polyp resection rate, retrieval rate, postoperative complications, and procedure time.Results 20 RCTs including 4 103 patients with 6 890 polyps were reviewed in the study. Among of them, 3 452 polyps in CSP and 3 438 polyps in HSP, respectively. Complete resection and en bloc resection rate using CSP were similar to HSP (RR＾ = 1.00, 95%CI: 0.98 ~ 1.01, P = 0.596; RR＾ = 0.98, 95%CI: 0.95 ~ 1.01, P = 0.222). There was no significant difference in the polyp retrieval rate between CSP and HSP (RR＾ = 1.00, 95%CI: 0.99~1.01, P = 0.824). Postoperative complications (intraoperative bleeding, delayed bleeding and perforation): the risk of intraoperative bleeding in CSP is higher than that of HSP (RR＾ = 1.66, 95%CI: 1.24 ~ 2.24, P = 0.001), and the risk of delayed bleeding in CSP is lower than HSP (RR＾ = 0.31, 95%CI: 0.16 ~ 0.63, P = 0.001), while the incidence of perforation was not significant (RR＾ = 0.33, 95%CI: 0.09 ~ 1.22, P = 0.097). The total operation time and polypectomy time in CSP were shorter than those in HSP (MD = -7.15, 95%CI: -8.25 ~ -6.06, P = 0.000; MD = -1.86, 95%CI: -2.85~-0.86, P = 0.000).Conclusion The curative effect of CSP for resecting small colorectal polyps is equivalent to that of HSP, but it can reduce the incidence of delayed bleeding and shorten the operation time. We recommend CSP for resecting small colorectal polyps.