经皮内镜下胃造瘘术与常规鼻饲治疗吞咽困难的系统评价

目的 根据现有的临床研究评价经皮内镜下胃造瘘与传统鼻胃管治疗吞咽困难患者的疗效与安全性进行系统评价.方法 检索Cochrane图书馆、PubMed、OVID数据库、中国期刊网、万方数据库和维普中文科技期刊全文数据库的英文和中文随机对照试验（RCT）文献,并提取纳入研究的特征信息.采用Revman 5.0与Stata 9.0软件进行meta分析,检验异质性,并根据异质性结果选择相应的效应模型.最后绘制漏斗图及Egger回归方程评定有无发表偏倚.结果 6项RCT,7D8例患者入选.与NGT组相比,PEG组的操作失败率、病死率、不良反应（腹腔及消化道出血,误吸及肺部感染）发生率的OR值分别为0.08（95%C1为0.00～2.18,P=0.13）、1.06（95%C1为0.45～2.47,P=0.89）、0.34（95%C1为0.15～0.77,P=0.01）、0.94（95%C1为0.63～1.39,P=0.75）;营养改善及生活质量方面无法进行定量分析;PEG组与NGT组在失败率、病死率、不良反应（腹腔或消化道出血,误吸或肺部感染）发生率的漏斗图均基本呈现下宽上窄左右对称的图形,提示无发表偏倚.结论 根据现有临床资料,对于吞咽困难患者,PEG与NGT治疗的操作失败率、病死率、误吸及肺部感染的发生率相似,而对于营养改善及生活质量方面的疗效不确切,需要今后有大样本、高质量的RCT进一步证实.

Percutaneous endoscopic gastrostomy and nasogastric tube for dysphagia patients: a systematic review

Objective To evaluate the efficacy and safety of percutaneous endoscopic gastrostomy （PEG） and nasogastric tube （NGT） in patients with dysphagia through systemic review. Methods The randomized clinical trials （RCT） that compared the efficacy or safety of percutaneous endoscopic gastrostomy and nasogastric feeding for dysphagia patients were searched from Pubmed, OVID, Cochrance Library, CNKI, Wanfang data and VIP Chinese Scientific and Technologic Periodical Database. Statistical heterogeneity between trials was evaluated by Revman 5.0 and Stata 9.0 and was considered to exist when P 〈 0.1. Heterogeneity of the included articles was tested, which was used to select proper effect model to calculate. Publication bias was investigated through visual inspection of funnel plots and Egger regression model. Results Six RCT including 708 cases were analyzed. When PEG was compared with NGT, the total OR of the operation failure rate, mortality, intraperitoneal and gastrointestinal bleeding, aspiration and pneumonia were 0.08 （95%CI 0.00 - 2.18,P= 0.13）, 1.06 （95%CI 0.45 ~ 2.47,P= 0.89）, 0.34 （95% CI 0.15 -0.77,P = 0.01）, 0.94 （95% CI 0.63 ~ 1.39,P = 0.75）, respectively. And it was not feasible for meta-analysis in the improvement of nutrition and quality of life. Inspection of the funnel plots for all outcomes measures did not reveal evidence of publi- cation bias. Conclusion The evidence currently available shows that failure rate of operation, mortality, aspiration and pneumonia of PEG and NGT for dysphagia patients are similar and there is still an uncertainty in improvement of nutrition and quality of life. Large-scale, high-quality RCTs are needed to confirm or refuse the available evidence.