内镜下乳头大球囊扩张术与括约肌切开联合大球囊扩张术治疗胆总管大结石有效性和安全性的Meta分析

李星志; 吴长伟; 任笠坤; 刘浩; 韩民

doi:10.3969/j.issn.1001-5256.2020.11.019

内镜下乳头大球囊扩张术与括约肌切开联合大球囊扩张术治疗胆总管大结石有效性和安全性的Meta分析

DOI: 10.3969/j.issn.1001-5256.2020.11.019

1. 贵州医科大学
2. 毕节市第一人民医院肝胆外科
3. 贵州医科大学附属医院肝胆外科

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中图分类号: R657.4
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出版历程
- 收稿日期: 2020-04-11
- 出版日期: 2020-11-20

Efficacy and safety of endoscopic papillary large balloon dilation alone versus endoscopic sphincterotomy combined with large balloon dilation in treatment of large common bile duct stones:A Meta-analysis

Guizhou Medical University
Department of Hepatobiliary Surgery,Bijie First People's Hospital
Department of Hepatobiliary Surgery,The Affiliated Hospital of Guizhou Medical University

摘要

摘要:
目的系统评价内镜下单纯乳头大球囊扩张术（EPLBD）和内镜下乳头括约肌切开联合大球囊扩张术（ESBD）在胆总管大结石（≥10 mm）治疗中的有效性和安全性。方法计算机检索PubMed、Embase、Cochrane library、CNKI、万方、维普数据库自建库至2020年3月的文献,由两名评审员筛选文献、提取资料以及质量评估,采用RevMan 5.3软件进行统计分析。结果共纳入11项研究,包括6项随机对照试验（RCT）和5项非随机对照试验（NRCT）,共计1282例患者。Meta分析结果示:在6项RCTs中,EPLBD组与ESBD组初次结石清除率（OR=0.71,95%CI:0.45～1.12,P=0.14）、总结石清除率（OR=1.39,95%CI:0.65～2.96,P=0.39）、机械碎石使用率（OR=1.19,95%CI:0.75～1.89,P=0.46）以及早期并发症发生率（OR=1.10,95%CI:0.60～2.03,P=0.75）差异均无统计学意义;在5项NRCTs中,两组间初次结石清除率（OR=0.64,95%CI:0.35～1.15,P=0.13）、总结石清除率...
- 胆总管结石病 /
- 括约肌切开术,内窥镜 /
- Meta分析（主题）
Abstract:
Objective To systematically review the efficacy and safety of endoscopic papillary large balloon dilation( EPLBD) versus endoscopic sphincterotomy combined with large balloon dilation( ESBD) in the treatment of large common bile duct stones( ≥10 mm). Methods Pubmed,Embase,Cochrane Library,CNKI,Wanfang Data,and VIP were searched for related articles published up to March 2020.Two reviewers independently performed article screening,data extraction,and quality assessment,and RevMan 5. 3 software was used for statistical analysis. Results A total of 11 studies( 6 randomized controlled trials and 5 non-randomized controlled trials) were included,with 1282 patients in total. The meta-analysis showed that in the 6 randomized controlled trials,there were no significant differences between the EPLBD group and the ESBD group in initial stone clearance rate( odds ratio [OR]= 0. 71,95% confidence interval [CI]: 0. 45-1. 12,P = 0. 14),overall stone clearance rate( OR = 1. 39,95% CI: 0. 65-2. 96,P = 0. 39),rate of use of mechanical lithotripsy( OR =1. 19,95% CI: 0. 75-1. 89,P = 0. 46),and incidence rate of early complications( OR = 1. 10,95% CI: 0. 60-2. 03,P = 0. 75); in the5 non-randomized controlled trials,there were no significant differences between the EPLBD group and the ESBD group in initial stone clearance rate( OR = 0. 64,95% CI: 0. 35-1. 15,P = 0. 13),overall stone clearance rate( OR = 0. 46,95% CI: 0. 19-1. 12,P =0. 09),and incidence rate of early complications( OR = 1. 20,95% CI: 0. 65-2. 21,P = 0. 56),but the EPLBD group had a significantly higher rate of use of mechanical lithotripsy than the ESBD group( OR = 1. 96,95% CI: 1. 26-3. 05,P = 0. 003). Conclusion EPLBD and ESBD have similar efficacy and safety in the treatment of large common bile duct stones,while EPLBD may increase the risk of the use of mechanical lithotripsy. More high-quality randomized controlled trials are needed to confirm this conclusion.
- choledocholithiasis /
- sphincterotomy,endoscopic /
- Meta-analysis as topic

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参考文献(33)

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