内镜下鼻胆管引流术治疗急性胰腺炎的系统评价

目的评价内镜下鼻胆管引流术治疗急性胰腺炎的临床疗效和安全性。方法通过计算机检索全面收集所有关于内镜下鼻胆管引流术治疗急性胰腺炎的随机对照试验／半随机对照试验，并辅以手工检索和其它检索。按照纳入标准纳入文献，由两名研究者独立筛选并提取资料，采用Handbook4．2．6推荐的质量评价标准评价纳入研究的方法学质量，采用RevMan4．2．10软件进行统计学处理。结果最终纳入8个研究，包括785例患者。Meta分析结果显示内镜下鼻胆管引流术＋常规治疗组与常规治疗组相比，在腹痛缓解天数（加权均数差-3．11．95％可信区间-4．54—1．69）、血清淀粉酶恢复正常时间（加权均数差-1．03，95％可信区间-1．62--0．43）、住院天数（加权均数差-9．60，95％可信区间-13．33—5．87）和并发症发生率（比值比0．24，95％可信区间0．10~0．54）方面差异均有统计学意义。结论当前研究显示，与常规治疗相比，内镜下鼻胆管引流术＋常规治疗能显著减少急性胰腺炎患者的腹痛缓解天数、血清淀粉酶恢复正常时间、住院天数和并发症发生率。由于纳入研究样本量较小且质量较低．上述结论尚需要高质量、大样本的随机双盲对照试验加以证实。

A Systematic Review of Endoscopic Naso-Biliary Drainage in the Treatment of Acute Pancreatitis

Objective To assess the efficacy and safety of endoscopic naso-biliary drainage (ENBD) plus conventional treatment to treat the acute pancreatitis. Methods We searched related database and identified randomized controlled trials or quasi-randomized controlled trials of ENBD plus conventional treatment versus conventional treatment to treat the acute pancreatitis. We evaluated the quality of the included studies by Handbook 4.2.6 recommend standard and analyzed data by Cochrane Collaboration's RevMan4.2.10. Results We included eight randomized controlled trials or quasi-randomized controlled trials (n=785). Meta analysis showed that there were differences between two groups in the days of abdomen pain relief (WMD=-3.11,95%CI -4.54～-1.69), serum amylase return to normal (WMD -1.03,95%CI -1.62～-0.43), days in hospital (WMD -9.60,95%CI -13.33～-5.87) and the incidence of complications (OR 0.24,95%CI 0.10～0.54). Conclusion The current evidence shows that contrast with conventional treatment, the ENBD plus conventional treatment can significantly reduce acute pancreatitis the days of abdomen pain relief, serum amylase return to normal, days in hospital and the incidence of complication incidences. Before recommendation to clinical practice, further high-quality, large-scale, randomized controlled trials are needed.