不同方法预防ERCP术后胰腺炎效果的Meta分析

Prevention of pancreatitis after endoscopic retrograde cholangiopancreatography with different methods: a Meta analysis

    摘要
  • 摘要: 目的:系统评价不同方法预防ERCP术后胰腺炎(PEP)的效果。
    方法:以endoscopic retrograde cholangiopancreatography、ERCP、postERCP pancreatitis、pancreatitis、pancreatic duct stent、nonsteroid antiinflammatory drugs、indometacin、diclofenac、protease inhibitors、nafamostat、ulinastatin、gabexate、somatostain、内镜逆行胰胆管造影、内镜逆行胰胆管造影术后胰腺炎、胰腺炎、胰管支架置入、非甾体类抗炎药、吲哚美辛、双氯芬酸、抑酶剂、萘莫司他、乌司他丁、加贝酯、生长 抑素为检索词检索PubMed、EMBASE、Cochrane Library、中国期刊全文数据库、中国生物医学文献数据库等数据库。检索时间为2000年 1月至2014年1月。最 终纳入研究预防PEP效果的相关随机对照试验，再由2名研究者独立筛查文献和提取数据，并进行文献质量评价。采用RevMan 5.0软件进行Meta分析。数据采用优势比(OR)及95%可信区间(95%CI)表示。采用I2对异质性进行分析。
    结果:共纳入符合标准的文献27篇，累计样本量8 293例，其中实验组［含胰管支架置入组、非甾体类抗炎药(NSAIDs)组、萘莫司他组、乌司他丁组、加贝酯组、生长抑素长期(静脉输注>6 h)输注组、生长抑素短期(静脉输注≤6 h)输注组、生长抑素静脉团注组］患者4 701例，对照组(采用无胰管支架置入或安慰剂对比)患者3 592例。Meta分析结果显示：与对照组比较，胰管支架置入组、NSAIDs组、萘莫司他组、生长抑素长期输注组和生长抑素静脉团注组患者PEP发生率显著降低，差异有统计学意义(OR=0.18，0.45，0.31，0.33，0.25，95%CI：0.09～0.35，0.33～0.61，0.19～0.52，0.20～0.56， 0.11～0.55， P<0.05)。
    结论:胰管支架置入、NSAIDs、萘莫司他、静脉输注生长抑素>6 h和静脉团注生长抑素能有效预防PEP的发生。

     

    Abstract: Objective:To evaluate the efficacy of different methods in preventing pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP).
    Methods:Databases including PubMed, EMBASE, Cochrane Library, Chinese Journal Full text Database, China Biomedicine Database were searched with key words including endoscopic retrograde cholangiopancreatography, ERCP, post ERCP pancreatitis, pancreatitis, pancreatic duct stent, non steroid anti inflammatory drugs, indometacin, diclofenac, protease inhibitors, nafamostat, ulinastatin, gabexate, somatostain, 内镜逆行胰胆管造影, 内镜逆行胰胆管造影术后胰腺炎, 胰腺炎, 胰管支架置入, 非甾体类抗炎药, 吲哚美辛, 双氯芬酸, 抑酶剂, 萘莫司他, 乌司他丁, 加贝酯 and 生长抑素. Literatures published between January 2000 and January 2014 were searched. Randomized controlled studies on prevention of pancreatitis after ERCP which were enrolled in this study were analyzed by 2 independent reviewers. The quality of the literatures was evaluated. All data were analyzed using the RevMan 5.0 software. Data were expressed in odds ratio (OR) and 95% confidence interval (95%CI). The heterogeneity of the studies was analyzed using the I 2 test.
    Results:Twenty seven literatures were enrolled in the study. There were 4 701 patients in the experimental group (including patients who were treated by pancreatic stent installation, non steroidal anti inflammatory drugs, nafamostat, ulinastatin, gabexate, intravenous infusion of somatostain for more than 6 hours, intravenous infusion of somatostain for less than 6 hours, bolus injection of somatostain) and 3 592 patients in the control group (including patients treated without pancreatic duct installation or placebo). The results of Meta analysis showed that pancreatic stent installation, non steroid anti inflammatory drugs, nafamostat, intravenous infusion of somatostain for more than 6 hours and bolus injection of somatostain could significantly decrease the incidence of pancreatitis after ERCP (OR=0.18, 0.45, 0.31, 0.33, 0.25, 95%CI: 0.09 -0.35, 0.33 -0.61, 0.19 -0.52, 0.20 -0.56, 0.11 -0.55, P<0.05).
    Conclusion:Pancreatic stent installation, non steroid anti inflammatory drugs, nafamostat, intravenous infusion of somatostain for more than 6 hours and bolus injection of somatostain could effectively prevent the incidence of pancreatitis after ERCP.

     

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