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Efficacy and safety of endoscopic vs surgical management of necrotizing pancreatitis: A meta-analysis

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Author:: No author available

Journal Title:: World Chinese Journal of Digestology

Issue:: 8

DOI:: 10.11569/wcjd.v28.i8.285

Key Word:: 坏死性胰腺炎;内镜;手术;Meta分析

Abstract：背景消化内镜和外科手术是治疗坏死性胰腺炎的两种主要有创方式,但比较二者疗效和安全性的研究尚缺乏.目的系统评价消化内镜和外科手术治疗坏死性胰腺炎的疗效和安全性.方法检索PubMed、EMBASE、Cochrane Library、中国知网、万方和中国生物医学文献数据库2000-01/2019-06发表的比较内镜和手术治疗坏死性胰腺炎的随机对照研究(randomized control trials,RCT)和队列研究,使用Revman5.3软件进行数据分析.结果共纳入8篇文献,其中3篇为RCT,5篇为队列研究.患者总数366例,其中内镜组167例,手术组199例.Meta分析结果显示:内镜组和手术组在临床缓解率(OR=1.3,95％CI: 0.58-2.92,P=0.52)、复合结局变量——主要并发症或死亡(RR=0.46,95％CI: 0.17-1.27,P=0.14)和死亡率(OR=0.78,95％CI: 0.37-1.56,P=0.52)上无统计学差异.术后并发症中,内镜组相比于手术组,新发器官衰竭(OR=0.40,95％CI: 0.18-0.90,P=0.03)、肠皮瘘或消化道穿孔(OR=0.46,95％CI: 0.23-0.91,P=0.02)、胰瘘(OR=0.09, 95％CI: 0.03-0.24,P＜0.00001)的发生率显著降低;而两组间术后腹腔出血、胰腺内分泌和胰腺外分泌功能不全的发生率无统计学差异.结论内镜和手术治疗坏死性胰腺炎的疗效无显著差异,但内镜可显著降低术后并发症的发生率.

Reference

[1]中华医学会消化病学分会胰腺疾病学组,《中华胰腺病杂志》编辑委员会,《中华消化杂志》编辑委员会.中国急性胰腺炎诊治指南（2019,沈阳）[J].2019,(5).
[2]罗德,苏松,刘向东,等.内镜经胃方式对比外科方式治疗感染坏死性胰腺炎的Meta分析[J].2018,(12).
[3]勾善淼,吴河水,张宇舜,等.坏死性胰腺炎外科干预模式的变迁及其疗效分析[J].2019,(10).
[4]Ji Young,Bang,Juan Pablo,Arnoletti,Bronte A,Holt,etc.An Endoscopic Transluminal Approach, Compared to Minimally Invasive Surgery, Reduces Complications and Costs for Patients With Necrotizing Pancreatitis.[J].2018.
[5]Khreiss, Mohammad,Zenati, Mazen,Clifford, Amber,etc.Cyst Gastrostomy and Necrosectomy for the Management of Sterile Walled-Off Pancreatic Necrosis: a Comparison of Minimally Invasive Surgical and Endoscopic Outcomes at a High-Volume Pancreatic Center[J].2015,19(8).
[6]Dirk Bausch,Stefan Utzolino,Tobias Keck,etc.Minimally invasive operations for acute necrotizing pancreatitis: Comparison of minimally invasive retroperitoneal necrosectomy with endoscopic transgastric necrosectomy[J].2012,152(3 Suppl.1).
[7]VanBrunschot,S.,Fockens,P.,Bakker,O.J.,etc.Endoscopic transluminal necrosectomy in necrotising pancreatitis: A systematic review[J].2014,28(5).
[8]Yong,Hu,Chunyan,Li,Xin,Zhao,etc.An endoscopic or minimally invasive surgical approach for infected necrotizing pancreatitis: a systematic review and meta-analysis.[J].2019,111.
[9]Puli, Srinivas R.,Graumlich, James F.,Pamulaparthy, Smitha R.,etc.Endoscopic transmural necrosectomy for walled-off pancreatic necrosis: A systematic review and meta-analysis[J].2014,28(1).
[10]Sandra van Brunschot,Janneke van Grinsven,Hjalmar C van Santvoort,etc.Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial[J].2018,391(10115).
[11]He, Wen-Hua,Zhu, Yong,Zhu, Yin,etc.The outcomes of initial endoscopic transluminal drainage are superior to percutaneous drainage for patients with infected pancreatic necrosis: a prospective cohort study[J].2017,31(7).
[12]Marianna, Arvanitakis,Jean-Marc, Dumonceau,J?rg, Albert,etc.Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines.[J].2018,(Spec ).
[13]Kurinchi Selvan Gurusamy,Ajay P Belgaumkar,Adam Haswell,etc.Interventions for necrotising pancreatitis[J].2016,137(3).
[14]Tan, Virianne,Charachon, Antoine,Lescot, Thomas,etc.Endoscopic transgastric versus surgical necrosectomy in infected pancreatic necrosis[J].2014,38(6).
[15]VanRamshorst,B.,Timmer,R.,Bakker,O.J.,etc.Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: A randomized trial[J].2012,307(10).
[16]Ross A,Crane R,Robinson D,etc.Endoscopic and percutaneous drainage of symptomatic walled-off pancreatic necrosis reduces hospital stay and radiographic resources.[J].2010,8(12).
[17]van Santvoort HC,Bakker OJ,Bollen TL,etc.A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome.[J].2011,141(4).
[18]Sandra, van Brunschot,Robbert A, Hollemans,Olaf J, Bakker,etc.Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients.[J].2017,(Spec ).
[19]van Santvoort HC,Besselink MG,Bakker OJ,etc.A step-up approach or open necrosectomy for necrotizing pancreatitis.[J].2010,362(16).