摘要
目的系统评价术后预防性放置鼻胆管引流术（ENBD）对经内镜逆行胰胆管造影术后胰腺炎（PEP）及高淀粉酶血症的有效性及安全性。方法计算机检索PubMed、Medline、EMBASE、CBM、CNKI及WanFangData，检索时限从建库至2014年2月24日，全面收集ENBD预防PEP的随机对照试验。由2位评价者按照纳入和排除标准独立选择文献、提取资料和评价质量后．采用RevMan 5．2软件进行Meta分析。结果共纳入14个临床对照研究，3143例拟行ERCP术的患者。Meta分析结果显示：观察组和对照组术后PEP发生率比较差异有统计学意义[OR=0．25，95％CI：0．17～0．36，P＜0．00001]，两组术后24h血清淀粉酶水平比较差异有统计学意义[OR=0．33，95％CI：0．23～0．46，P＜0．00001]，内镜下鼻胆管引流术能减少术后胰腺炎和高淀粉酶血症的发生率。结论术后预防性放置鼻胆管引流可以有效降低ERCP术后胰腺炎及高淀粉酶血症的发生率。但因原始研究的质量限制，需要更多大样本、高质量、设计严谨的随机对照试验论证以上结论。
Objective To systematically review the effectiveness and safety of endoscopic nasobiliary drainage in preventing post-endoscopic retrograde cholangiopancreatography panereatitis （PEP） and hyperamylasemia. Methods Electronic searches were conducted to connect randomized controlled trials comparing ENBD to placebo in the prevention of PEP from the PubMed, Medline, EMBASE, CBM, CNKI and WanFang Data. All ISI were searched from their establishment to February 24, 2014. According to the inclusion and exclusion criteria, literature identification, data extraction, and quality assessment were performed by two reviewers independently. Then, RevMan 5.2 software was used for Metaanalysis. Results A total of 14 randomized controlled trials involving 3143 patients were included. The Meta-analysis showed that incidence of PEP between obsenvation group and control group was statistically significant （OR = 0.11, 95%CI： 0.05-0.27, P 〈0.1300 01）, incidence of hyperamylasemia was statistically significant （OR = 0.27, 95%CI： 0.18- 0.42, P 〈0.000 01）. Endoscopic nasobiliary drainage could reduce the incidence of PEP and hyperamylasemia. Conclusion ENBD is safe and effective in reducing the incidence of PEP and hyperamylasemia. Due to the limitation of quality of the original studies, this consequence has to be confirmed by more large scale, high quality and rigorously designed of randomized controlled trials.
出处
《中国医药导报》
CAS
2014年第28期43-46,50,共5页
China Medical Herald
