球囊扩张和Heller肌切开治疗儿童贲门失弛缓症的meta分析

目的 采用meta分析来系统评价已有的关于儿童贲门失弛缓症的文献，对比分析球囊扩张（BD）和Heller肌切开（HM）治疗儿童贲门失弛缓症的有效性和安全性。方法 检索Pubmed、Embase、Chocane Library Database，CBMDisc，维普全文数据库，万方生物医学期刊数据库。检索的时间均从建库至2012年5月。获得BD和HM治疗儿童贲门失弛缓症的临床对照研究的文献。由两名系统评价员进行资料提取和质量评价。应用Revman5.0软件进行meta分析，根据异质性结果选择相应的效应模型分析；无法进行meta分析时采用描述性分析。结果 最终纳入8篇文献，均为回顾性的对照研究，无随机对照研究。8篇文献均报道了两组的复发率和并发症发生率。BD组与HM组治疗儿童贲门失弛缓症的复发率之间的差异存在统计学意义（95%CI：[1.87,8.11]，P=0.0003），HM组的复发率低于BD组（OR值=3.90）。两组并发症发生率之间的差异亦存在统计学意义（95%CI：[0.15,0.90]，P=0.03），BD组的并发症发生率低于HM组（OR值=0.37）。结论 HM治疗儿童贲门失弛缓症的复发率低于BD，而其并发症的发生率却高于BD。但因为纳入均为回顾性研究，该结论尚待进一步的随机对照研究来证实。

A meta-analysis of balloon dilation vs. Heller myotomy for achalasia in children

Abstract Objectives It is unclear whether balloon dilation (BD) was superior or inferior to Heller myotomy (HM) for achalasia in children.So this study was aimed to undertake a systematic review comparing the efficacy and safety of balloon dilation (BD) to Heller myotomy (HM) in the treatment of achalasia in children. Methods Databases, including Pubmed,Embase,Chocrane Library Database,CBMDisc,CMJD and Wanfang data ,were searched to identify studies comparing BD and HM for achalasia in children from database establishment to May of 2012.The key words were achalasia and children.Two reviewers assessed the quality and extracted data.Software Revman 5.0 was used to perform meta analysis.Heterogeneity of the included studies was tested to select a proper effect model. Results Eight retrospective studies were included to assess the recurrence rate and complication rate.The recurrence rate was lower in HM group than in BD group (OR=4.07,95%CI:[1.41,11.69],P=0.009),but the complication rate was lower in BD group than in HM group (OR=0.37,95%CI:[0.15,0.90],P=0.03). Conclusions The recurrence rate was lower in HM group than in BD group but the complication rate was lower in BD group than in HM group.Yet these results need to be confirmed by further randomized controlled studies considering that all the 8 included studies were retrospective.