内镜下气囊扩张治疗贲门失弛缓症的系统评价

目的系统评价内镜下气囊扩张治疗贲门失弛缓症的有效性和安全性。方法计算机检索Cochrane图书馆临床对照试验数据库(2007年第1期)、MEDLINE(1978～2007年)、EMbase(1978～2007年)、OVID数据库(1978~2007年)、中国生物医学文献数据库(1978～2007年)、维普中文期刊数据库(1989～2007年)、中国期刊全文数据库(1979～2007年)和万方学位论文数据库(1978～2007年),手工检索相关会议论文集及所获文献的参考文献,全面收集全世界关于内镜下气囊扩张治疗贲门失弛缓症的随机对照试验。按Cochrane协作网推荐的方法进行系统评价。结果共纳入24个RCT,包括1045例患者。Meta分析结果显示:①短期总有效率:内镜下气囊扩张治疗优于内镜下注射肉毒杆菌毒素治疗OR0.47,95%CI(0.30,0.73);P=0.0007]。②长期总有效率:内镜下气囊扩张治疗优于内镜下注射肉毒杆菌毒素治疗OR0.31,95%CI(0.13,0.70);P=0.005]。③临床复发率:内镜下注射肉毒杆菌毒素治疗高于内镜下气囊扩张治疗OR8.88,95%CI(3.31,23.79);P<0.0001]。④副作用及并发症发生率:内镜下气囊扩张治疗高于内镜下注射肉毒杆菌毒素治疗OR0.14,95%CI(0.04,0.44);P=0.0008];经腹开放性括约肌切开治疗高于内镜下气囊扩张治疗OR0.15,95%CI(0.05,0.44);P=0.0006]。结论目前的证据表明,内镜下气囊扩张治疗具有较好的长短期疗效,且操作简单方便,不良反应少,建议在临床实践中依患者病情选用。

Pneumatic Balloon Dilatation for Achalasia:A Systematic Review of Randomized Controlled Trials

Objective To determine the effectiveness and safety of pneumaticballoon dilatation in patients with achalasia.Methods We searched the Cochrane Central Register of Controlled Trials(CENTRAL,issue 1,2007), MEDLINE or PUBMED(1978-2007),Embase(1978-2007), OVID Database(1978-2007),Chinese Biological Medicine Database(CBMDisc,1978-2007),CNKI(1979-2007),Chinese VIPDatabase(1989-2007)and Wanfang Database(1978-2007). We also checked the reference l ists of retrieved articles and relevant proceedings.We used the methods recommended by The Cochrane Collaboration to conduct this systematic review.Results Twenty four trials involving 1 045 patients were included.Meta-analyses showed that the short-term total effective rate was much higher with pneumaticdilatationthan intrasphinctericbotul inum toxin injection(P=0.000 7). The long-term total effective rate was higher with pneumatic dilatation compared to intrasphincteric botul inum toxin injection(P=0.005).Intrasphinctericbotulinum toxin injection was superior to pneumatic dilatation in terms of cl inical relapse rate(P<0.000 1).Our analyses of compl ications and adverse effects found that pneumaticdilatation was superior to intrasphinctericbotul inum toxin injection(P=0.000 8),and endoscopicsphincterotomy was superior to balloon dilatation (P=0.000 6).Conclusions The l imited current evidence shows that:pneumaticdilatation is safe and effective for the short-or long-term treatment of achalasia.