内镜下乳头球囊扩张术对比乳头括约肌切开术治疗胆总管结石的Meta分析

被引：14

作者：

鲁超

锁涛

付亮

张钰

宋陆军

机构：

[1] 复旦大学附属中山医院普外科

来源：

中华消化内镜杂志 | 2013年 / 04期

关键词：

胆总管结石; 括约肌切开术,内窥镜; 内镜下乳头球囊扩张术; Meta分析;

D O I：

暂无

中图分类号：

R657 [];

学科分类号：

摘要：

目的对比内镜下乳头球囊扩张术(EPBD)与内镜乳头括约肌切开术(EST)治疗胆总管结石的利与弊。方法检索Cochrane Library、Embase、Medline、Pubmed、CBM、CN KI、VIP和万方数据库,没有语言限制。纳入从1983年1月到2012年9月间发表的比较EPBD与EST治疗胆总管结石的临床随机对照实验,并对其进行了质量学评价,最后用RevMan 5.1软件进行Meta分析。结果 18个临床随机对照实验符合研究标准(2385个研究对象)。在第一次成功取石率、总成功取石率、穿孔、长期胆管炎发生率等方面EPBD与EST结果类似。EPBD有更高的危险发生胰腺炎(RR=1.99,95%CI:1.41～2.81)和重症胰腺炎(RR=4.68,95%CI:1.36～16.11),需要机械碎石的概率更高(RR=1.31,95%CI:1.14～1.50)。相反的是,EPBD不但有明显低的出血率(RR=0.14,95%CI:0.06～0.34),而且长期结石复发(RR=0.67,95%CI:0.47～0.96),长期胆囊炎(RR=0.38,95%CI:0.19～0.76)和总的长期并发症(RR=0.52,95%CI:0.40～0.67)发生率更低。结论考虑出血、结石复发或长期并发症的话,相对于EST,EPBD治疗胆总管结石是更好的选择;但后者胰腺炎尤其是重症胰腺炎的发生率更高。

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