Department of Hepatobiliary Surgery and Liver Transplantation, St Vincent's University Hospital, Dublin, Ireland.
Professorial Surgical Unit, Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland.
Dig Surg. 2024;41(1):1-11. doi: 10.1159/000535588. Epub 2024 Jan 8.
Debate exists regarding the optimal treatment for painful chronic pancreatitis (CP). This meta-analysis aims to determine the outcomes of surgical intervention as compared to endoscopy in patients with painful CP.
A systematic review and meta-analysis including studies from PubMed, Embase, Web of Science, and Cochrane Databases (1995 onwards) was done by two independent reviewers using PRISMA guidelines. Primary outcome was pain relief.
Among 8,479 studies, three were randomized trials, comprising a total of 199 patients. Compared with endoscopy, surgery was associated with a lower Izbicki score, both at medium term (mean difference (MD) 21.46, 95% confidence interval (CI) 13.48-29.43, p < 0.00001) and long term (MD: 17.80, 95% CI: 8.36-27.23, p = 0.0002). A higher proportion of surgical patients had some sort of pain relief compared with those who had endoscopy, both at medium term (72% vs. 46%, RR: 1.51, 95% CI: 1.19-1.90, p = 0.0006) and long term (73% vs. 47%, RR: 1.50, 95% CI: 1.19-1.89, p = 0.0007). Complete pain relief was more common in the surgical group compared to the endoscopy group, both at medium term (33% vs. 17%, RR: 1.97, 95% CI: 1.16-3.36, p = 0.01) and long term (35% vs. 18%, RR: 1.92, 95% CI: 1.15-3.20, p = 0.01). The pooled crossover rate from endoscopy to surgery was 22% (22/99).
Surgical treatment in patients with painful CP leads to better pain control, requiring fewer interventions as compared to endoscopic treatment.
对于疼痛性慢性胰腺炎（CP），哪种治疗方式最优仍存在争议。本荟萃分析旨在比较内镜治疗与手术治疗对疼痛性 CP 患者的疗效。
通过对 PubMed、Embase、Web of Science 和 Cochrane 数据库（1995 年及以后）进行系统评价和荟萃分析，两位独立评审员使用 PRISMA 指南进行筛选。主要结局为疼痛缓解。
在 8479 项研究中，有 3 项为随机试验，共纳入 199 名患者。与内镜治疗相比，手术治疗在中期（平均差值（MD）：21.46，95%置信区间（CI）：13.48-29.43，p < 0.00001）和长期（MD：17.80，95%CI：8.36-27.23，p = 0.0002）时，Izbicki 评分均更低。手术治疗的患者中，有某种程度疼痛缓解的比例高于内镜治疗的患者，中期（72%比 46%，RR：1.51，95%CI：1.19-1.90，p = 0.0006）和长期（73%比 47%，RR：1.50，95%CI：1.19-1.89，p = 0.0007）时均如此。与内镜治疗相比，手术治疗的患者在中期（33%比 17%，RR：1.97，95%CI：1.16-3.36，p = 0.01）和长期（35%比 18%，RR：1.92，95%CI：1.15-3.20，p = 0.01）时完全疼痛缓解的比例更高。内镜治疗转为手术治疗的患者比例为 22%（22/99）。
与内镜治疗相比，手术治疗疼痛性 CP 患者的疼痛控制效果更好，需要的干预更少。
