Tang Peng, Zha Qinqing, Zhou Lihua, Yang Qiulian, He Mingfeng, Zhu Shaomin, Liu Yan
Department of Gastroenterology, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.
Digestive Endoscopy Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.
Gland Surg. 2021 Sep;10(9):2754-2765. doi: 10.21037/gs-21-516.
Digestive endoscopy and surgery are the primary invasive methods for the clinical treatment of necrotizing pancreatitis. However, there are relatively few studies evaluating the effectiveness and safety of these two methods.
Randomized controlled trials (RCTs) on endoscopic and surgical treatment of necrotizing pancreatitis published from January 2000 to December 2020 were searched in the PubMed, Medline, Embase, China Biology Medicine Disc (CBM), and WanFang databases. The was adopted to evaluate the quality of the included literature, and Review Manager 5.3 was used for data analysis.
Ten articles were included in this meta-analysis, involving a total of 401 patients, including 188 in the endoscopy group and 213 in the surgery group. Meta-analysis results revealed that the clinical remission rate (CRR) [odds ratio (OR) =1.30, 95% confidence interval (CI): 0.58-2.92, P=0.52], new organ failure rate (OFR) (OR =0.53, 95% CI: 0.26-1.09, P=0.08), abdominal bleeding rate (ABR) (OR =0.62, 95% CI: 0.33-1.15, P=0.13), and intensive care unit (ICU) stay time (IST) [mean deviation (MD) =-7.33, 95% CI: -16.76 to 2.11, P=0.13] were not significantly different between the endoscopy and surgery groups. In the endoscopy group, the mortality rate (OR =0.56, 95% CI: 0.31-1.02, P=0.05), intestinal fistula rate (IFR) or gastrointestinal perforation rate (GPR) (OR =0.50, 95% CI: 0.26-0.99, P=0.05), and pancreatic fistula rate (PFR) (OR =0.09, 95% CI: 0.04-0.23, P<0.00001) were markedly lower compared to the surgery group.
There was no obvious difference in the clinical efficacy of endoscopic and surgical treatment of necrotizing pancreatitis. However, endoscopy can greatly reduce the incidence of postoperative death and major complications in patients.
消化内镜检查和手术是坏死性胰腺炎临床治疗的主要侵入性方法。然而，评估这两种方法有效性和安全性的研究相对较少。
检索2000年1月至2020年12月在PubMed、Medline、Embase、中国生物医学文献数据库（CBM）和万方数据库中发表的关于坏死性胰腺炎内镜和手术治疗的随机对照试验（RCT）。采用 评估纳入文献的质量，并使用Review Manager 5.3进行数据分析。
本荟萃分析纳入10篇文章，共涉及401例患者，其中内镜组188例，手术组213例。荟萃分析结果显示，内镜组和手术组的临床缓解率（CRR）[比值比（OR）=1.30，95%置信区间（CI）：0.58 - 2.92，P = 0.52]、新器官衰竭率（OFR）（OR = 0.53，95% CI：0.26 - 1.09，P = 0.08）、腹腔出血率（ABR）（OR = 0.62，95% CI：0.33 - 1.15，P = 0.13）和重症监护病房（ICU）住院时间（IST）[平均差（MD）=-7.33，95% CI：-16.76至2.11，P = 0.13]无显著差异。在内镜组中，死亡率（OR = 0.56，95% CI：0.31 - 1.02，P = 0.05）、肠瘘率（IFR）或胃肠道穿孔率（GPR）（OR = 0.50，95% CI：0.26 - 0.99，P = 0.05）以及胰瘘率（PFR）（OR = 0.09，95% CI：0.04 - 0.23，P < 0.00001）明显低于手术组。
坏死性胰腺炎内镜和手术治疗的临床疗效无明显差异。然而，内镜检查可大大降低患者术后死亡和主要并发症的发生率。
