摘要
目的 评价早期内镜逆行胰胆管造影（ERCP）联合内镜下乳头括约肌切开术（EST）与保守治疗在急性胆源性胰腺炎（ABP）中的临床疗效和安全性.方法 以“Endoscopic retrograde cholangiopancreatography＂“Endoscopic sphincterotomy”“ERCP”“EST＂“Pancreatitis”“Biliary pancreatitis”“内镜逆行胰胆管造影”“内镜下乳头括约肌切开术”“胆源性胰腺炎”为关键词通过计算机检索PubMed、EMBASE、Cochrane Library、中国生物医学文献数据库、中国知网全文数据库、万方和维普数据库,收集国内外早期ERCP联合EST与早期保守治疗ABP的随机对照试验（RCT）,检索时限为建库至2017年9月.由2名研究者独立按病例纳入与排除标准进行文献筛选、资料提取和纳入研究的偏倚风险评价.比较早期ERCP联合EST与保守治疗治疗ABP的病死率、并发症发生率、相关并发症和住院时间.采用RevMan 5.3软件完成Meta分析.结果 最终纳入10项RCT,共1 752例患者.Meta分析结果显示,与保守治疗相比,早期行ERCP及EST能降低ABP的全身并发症发生率（RR=0.66;95％ CI：0.47 ～0.93,P＜0.05）;在ABP整体病死率、局部并发症发生率及择期行ERCP及EST的ERCP相关并发症发生率方面差异均无统计学意义（P＞0.05）.亚组分析提示,早期行ERCP及EST能降低重症急性胆源性胰腺炎（SABP）、合并胆道梗阻ABP及住院24 h内行该治疗ABP患者的病死率（RR =0.48、0.35、0.25;95％ CI：0.24～0.96、0.17 ～0.74、0.09～0.73,P＜0.05）;分别减少SABP、合并胆道梗阻ABP的局部和全身并发症发生率（RR=0.56、0.54、0.51、0.51;95％CI：0.37～0.86、0.33 ～0.91、0.32～0.81、0.32～0.80;P＜0.05）;降低合并胆道梗阻的SABP局部和全身并发症发生率（RR =0.42、0.47;95％CI：0.25 ～0.70、0.25～0.87;P＜0.05）;缩短SABP患者的住院时间（MD=-11.22 d;95％ CI：-16.09 ～-6.36;P＜0.01）.但对于不伴胆道梗阻的ABP的并发症发生率和轻症ABP的住院时间未显著改善.结论 与早期保守治疗相比,早期行ERCP联合EST治疗ABP安全有效.
Objective To evaluate the efficacy and safety of early endoscopic retrograde cholangiopancreatography （ERCP） with endoscopic sphincterotomy （EST） in patients of acute biliary pancreatitis （ABP）.Methods Databases including PubMed,EMBASE,Cochrane library,CBM,CNKI,WanFang data and VIP data were searched with ＂ Endoscopic retrograde cholangiopancreatography＂ ＂Endoscopic sphincterotomy＂ ＂ERCP＂ ＂Pancreatitis＂ ＂Biliary pancreatitis＂ resection up to September 2017.Randomized controlled trails （RCTs） conternming the comparison of ERCP with EST versus conservative management in ABP patients were enrolled in the study.Two reviewers independently screened literature,extracted data,and assess the risk of bias of the included studies.The Meta-analysis was conducted by RevMan 5.3 software.Results A total of 10 RCTs involving 1 752 cases were included in the Metaanalysis.The results of Meta-analysis showed that compared with the control group,early ERCP with EST reduced the systemic complication rate of ABP （RR =0.66;95% CI：0.47-0.93;P 〈 0.05）.However,there were no significant differences in overall mortality,local complication rate,and ERCP related complication rate in ABP between early and selected ERCP with EST treat （P 〉 0.05）.Subgroup analyses indicated that early ERCP with EST therapy reduced the mortality of severe acute biliary pancreatitis （SABP）,ABP with biliary obstruction and within 24 hours of admission （RR =0.48,0.35,0.25;95% CI：0.24-0.96,0.17-0.74,0.09-0.73;P 〈 0.05）;decreased the local and systemic complication rate of SABP,ABP with biliary obstruction （RR =0.56,0.54,0.51,0.51;95% CI：0.37-0.86,0.33-0.91,0.32-0.81,0.32-0.80;P 〈 0.05）;reduced the local and systemic complication rate of SABP （RR =0.42,0.47;95% CI：0.25-0.70,0.25-0.87;P 〈0.05） and shortened the hospital stay of SABP （MD =-11.22 d;95% CI：-16.09--6.36;P 〈 0.01）.However,there were no significant differences of overall complication rate in ABP without biliary obstruction and hospital stay in MABP.Conclusion Early ERCP with EST therapy appears to be safe and effective for ABP patients.
作者
孙建明
朱卓立
李静
刘明忠
李生伟
龚建平
Sun Jianming;Zhu Zhuoli;Li Jing;Liu Mingzhong;Li Shengwei;Gong Jianping(Department of Hepatobiliary Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China)
出处
《国际外科学杂志》
2018年第5期305-313,共9页
International Journal of Surgery
作者简介
通信作者：龚建平，Emait：gongiianping11@126．com
