十二指肠乳头括约肌切开后球囊扩张术和乳头括约肌切开术治疗巨大胆总管结石效果比较的Meta分析

目的评价两种手术方式十二指肠乳头括约肌切开术(EST)和十二指肠乳头括约肌切开后球囊扩张术(ESBD)处理巨大胆总管结石的疗效差异。方法计算机检索至2019年7月8日的Pubmed、Cochrane Central、Embase等外文数据库及中国知网、万方等中文数据库中的文献,同时检索相关会议论文等,纳入ESBD vs EST治疗巨大胆总管结石的随机对照试验(RCT),提取相关数据,采用RevMan5.3软件进行分析。结果共纳入13项RCT,共计1926例患者,其中ESBD组973例,EST组953例。Meta分析结果显示:ESBD组和EST组结石清除率比值比(OR)=1.53,95%可信区间(95%CI):1.03~2.29,P=0.04]、一次清除率(OR=1.77,95%CI:1.06~2.93,P=0.03)、机械碎石率(OR=0.40,95%CI:0.25~0.63,P<0.0001)、出血率(OR=0.23,95%CI:0.11~0.50,P<0.001)、胆管炎发生率(OR=0.31,95%CI:0.12~0.78,P=0.01)、早期并发症(OR=0.59,95%CI:0.42~0.84,P=0.003)、手术时间(MD=-8.89,95%CI:-17.56^-0.22,P=0.04)比较,差异均有统计学意义;但在穿孔(OR=0.27,95%CI:0.05~1.30,P=0.10)、内镜后胰腺炎(OR=1.03,95%CI:0.66~1.61,P=0.91)方面二者结果相似。结论在内镜下处理巨大胆总管结石中,ESBD在结石清除率、机械碎石率、出血率、胆管炎发生率、手术时间方面比EST更有优势。

Clinical effect of endoscopic sphincterotomy with balloon dilation versus sphincterotomy alone in treatment of large common bile duct stones:A Meta-analysis

Objective To investigate the clinical effect of endoscopic sphincterotomy with balloon dilation(ESBD)versus sphincterotomy(EST)alone in the treatment of large common bile duct stones.Methods Foreign databases(including PubMed,Cochrane Central,and Embase)and Chinese databases(including CNKI and Wanfang Data)were searched for randomized controlled trials(RCTs)on the clinical effect of ESBD versus EST in the treatment of large common bile duct stones published up to July 8,2019.Related data were extracted and RevMan5.3 was used for analysis.Results A total of 13 RCTs with 1926 patients were included,with 973 patients in the ESBD group and 953 patients in the EST group.The meta-analysis showed that there were significant differences between the ESBD group and the EST group in stone clearance rate(odds ratioOR]=1.53,95%confidence intervalCI]:1.03-2.29,P=0.04),one-time clearance rate(OR=1.77,95%CI:1.06-2.93,P=0.03),rate of use of mechanical lithotripsy(OR=0.40,95%CI:0.25-0.63,P<0.0001),bleeding rate(OR=0.23,95%CI:0.11-0.50,P<0.001),incidence rate of cholangitis(OR=0.31,95%CI:0.12-0.78,P=0.01),incidence rate of early complications(OR=0.59,95%CI:0.42-0.84,P=0.003),and time of operation(mean difference=-8.89,95%CI:-17.56 to-0.22,P=0.04),while there were no significant differences between the two groups in perforation(OR=0.27,95%CI:0.05-1.30,P=0.10)and pancreatitis after endoscopy(OR=1.03,95%CI:0.66-1.61,P=0.91).Conclusion In endoscopic treatment of large common bile duct stones,ESBD has several advantages over EST in stone clearance rate,rate of use of mechanical lithotripsy,bleeding rate,incidence rate of cholangitis,and time of operation.