荟萃分析:超声内镜和ERCP诊断胆总管结石的比较

目的 通过荟萃分析对超声内镜和ERCP对胆总管结石诊断能力进行比较.方法 从Pubmed、Embase、Elsevier Science Direct和中国期刊全文数据库中检索比较超声内镜和ERCP对怀疑有胆总管结石病人诊断能力的前瞻性研究.对各项研究中的敏感性、特异性、准确率的比数比(OR)行荟萃分析,采用固定效应模型或随机效应模型进行数据统计分析.结果 共有5项对照研究入选(n=325).超声内镜的敏感性显著高于ERCP(146/159 vs 134/159,固定效应模型:OR 2.02,95%CI=1.01-4.03,P=0.05).超声内镜和ERCP对检测胆总管结石的特异性相似(161/166 vs 164/166,固定效应模型:OR 0.49,95% CI=0.12-1.99,P＞0.05).超声内镜的准确性略高于ERCP,但没有显著性差异(307/325 vs 298/325,固定效应模型:OR 1.53,95% CI=0.83-2.80,P＞0.05).ERCP相关的不良反应发生率显著高于超声内镜(P＜0.01).结论 由于准确率、安全性高,侵入性相对较小,超声内镜可认为是诊断胆总管结石的理想检查项目并能替代诊断性ERCP.对于这两种方法 的选择,应该取决于病人的一般状况、医疗单位所具备的能力,以及病灶是否可能需要采取进一步的介入治疗.

Meta-analysis: endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in the diagnosis of choledocholithiasis

Objective Derforming a meta-analysis to evaluate the ability of EUS compared to ERCP for the diagnosis of choledocholithiasis.Methods Pubmed,Embase,Elsevier Science Direct,the China Academic Journals Fulltext Database,were searched for prospective trials comparing the diagnostic efficacy of EUS and ERCP in patients with a suspicion of choledocholithiasis.Meta-analysis was used to analyze odds ratio(OR)of the sensitivity,specificity,and accuracy of the two tests,fixed or random model method was used for data analysis.Results Five studies(n=325)in which the diagnostic ability of EUS and ERCP had been prospectively compared in patients with a suspicion of choledocholithiasis were collected.The sensitivity of EUS was significantly higher than that of ERCP(146/159 vs 134/159,fixed model:OR 2.02,95%CI=1.01-4.03,P=0.05).EUS and ERCP were of similar specificity for the detection of Common bileduct stones(161/166 vs 164/166,fixed model:OR 0.49,95%CI=0.12-1.99,P>0.05).The accuracy of EUS was higher than that of ERCP,but not significantly(307/325 vs 298/325,fixed model:OR 1.53,95%CI=0.83-2.80,P>0.05).The incidence of adverse events of ERCP was significantly higher than that of EUS(P<0.01).Conclusions Owing to high accuracy,safety and relatively low cost,EUS seems to be suitable alternative for detection of bile duct stones.Choice for initial test should depend on patient's physical status,technology availability,and potential for therapeutic intervention.