胰管支架置入術預防內鏡逆行胰膽管造影術后胰腺炎的系統評價_《中國循證醫學雜志》

作者：

潘濤 , 王一平 , 楊錦林 , 田玲 , 李耀東

四川大學華西醫院消化內科,成都,610041;

關鍵詞：

內鏡逆行胰膽管造影術后胰腺炎胰管支架置入術隨機對照試驗系統評價

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目的　評價胰管支架置入術能否降低內鏡逆行胰膽管造影(endoscopic retryrade cholangio pancreatograph,ERCP)術后胰腺炎(post-ERCP pancredtitis,PEP)高危患者PEP的發生率、嚴重程度及其臨床應用的安全性.
方法　計算機檢索Cochrane上消化道和胰腺專業臨床試驗資料庫(2004年第1期)、Cochrane臨床對照試驗資料庫(2004年第1期、MEDLINE(1966-2004.4)、EMBASE(1985～2004.4)、中國生物醫學文獻數據庫(1970～2004.4)以及中國循證醫學中心隨機對照試驗資料庫,手工檢索8種相關中文期刊及所獲文獻的參考文獻,全面收集全世界關于胰管支架置入術預防PEP的臨床隨機對照試驗,并按Cochrane協作網推薦的方法進行系統評價.
結果　共6篇RCT包括468例PEP高危患者被納入評價.Meta分析結果顯示,胰管支架置入術可降低PEP高危患者PEP的發生率[Peto RR 0 31,95 CI(0.19,0.52);P＜0.000 01;NNT=6]及重度PEP的發生率[Peto OR0.13,95％CI(0.04,0.47);P=0.002;NNT=24].上述結果均與敏感性分析的結果一致.
結論　胰管支架置入術可降低PEP高危患者PEP的發生率和重度PEP的發生率,可能是預防PEP的有效方法.但由于能夠納入系統評價的試驗有限且存在方法學上的局限性,尚需謹慎地看待這一結論.

引用本文： 潘濤,王一平,楊錦林,田玲,李耀東. 胰管支架置入術預防內鏡逆行胰膽管造影術后胰腺炎的系統評價. 中國循證醫學雜志, 2004, 04(10): 693-699. doi: 復制

1.	［1］Cotton PB, Lehman G, Vennes JA, Geenen JE, Russell RCG, Meyers WC, Liguory C, Nickl N. Endoscopic sphincterotomy complications and their management: an attempt at consensus [J]. Gastrointest Endosc, 1991; 37 (3):383 - 393.
2.	［2］Freeman ML, Disario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ, Overby CS, Aas J, Ryan ME, Bochna GS, Shaw MJ, Snady HW, Erickson RV, Moore JP, Roel JP. Risk factors for post-ERCP pancreatitis: a prospective,multicenter study [J]. Gastrointest Endosc, 2001; 54 (4):425 - 434.
3.	［3］Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, Minoli G, Crosta C, Comin U, Fertitta A, Prada A,Passoni GR, Testoni PA. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study [J]. Am J Gastroenterol, 2001; 96(2): 417-423.
4.	［4］Loperfido S, Angelini G, Benedetti G, Chilovi F, Costan F,De Berardinis F, De Bernardin M, Ederle A, Fina P, Fratton A. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study [J]. Gastrointest En dosc,1998; 48(1):1 -10.
5.	［5］Smithline A, Silverman W, Rogers D, Nisi R, Wiersma M,Jamidar P, Hawes R, Lehman G. Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopicsphincterotomy-induced pancreatitis in high-risk patients [J].Gastrointest Endosc, 1993;39(5): 652 - 657.
6.	［6］Sherman S, Earle FD, Bucksot L, Esber E, Pezzi J,Gottlieb K, Lehman G. Does leaving a main pancreatic duct stent in place reduced the incidence of precut biliary sphincterotomy(ES)-induced pancreatitis [J] ? Am J Gastroenterol, 1995;90(9):1 614.
7.	［7］Meyerson SM, Geenen JE, Johnson GK, Catalano MF,Geenen DJ, Schmalz MJ Hogan WJ. Pancreatic duct stenting decreases the incidence of post-ERCP pancreatitis: a prospective randomized study [J]. Gastroenterology, 1998; 114(4):G1 967.
8.	［8］Tarnasky PR, Palesch YY, Cunningham JT, Mauldin PD,Cotton PB, Hawes RH. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction [J]. Gastroenterology, 1998;115(12):1518-1524.
9.	［9］Patel R, Tarnasky PR, Hennessy WS, Hawes RH, Payne KM, Nelles SE, Cunningham JT, Cotton PB. Does stenting after pancreatic sphincterotomy reduced post-ERCP pancreatitis in patients with prior biliary sphincterotomy: preliminary results of a prospective randomized trial [J]. Gastrointest Endosc, 1999; 49(4):80.
10.	［10］Fazel A, Quadri A, Catalano MF, Meyerson SM, Geenen JE. Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study [J]. Gastrointest Endosc,2003; 57(3): 291 -294.
11.	［11］Sherman S, Lehman GA. ERCP and endoscopic sphincterotomy-induced pancreatitis [J].Pancreas,1991;6(2): 350-367.
12.	［12］Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials [J].JAMA, 1995; 273(5): 408-412.

1. ［1］Cotton PB, Lehman G, Vennes JA, Geenen JE, Russell RCG, Meyers WC, Liguory C, Nickl N. Endoscopic sphincterotomy complications and their management: an attempt at consensus [J]. Gastrointest Endosc, 1991; 37 (3):383 - 393.
2. ［2］Freeman ML, Disario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ, Overby CS, Aas J, Ryan ME, Bochna GS, Shaw MJ, Snady HW, Erickson RV, Moore JP, Roel JP. Risk factors for post-ERCP pancreatitis: a prospective,multicenter study [J]. Gastrointest Endosc, 2001; 54 (4):425 - 434.
3. ［3］Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, Minoli G, Crosta C, Comin U, Fertitta A, Prada A,Passoni GR, Testoni PA. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study [J]. Am J Gastroenterol, 2001; 96(2): 417-423.
4. ［4］Loperfido S, Angelini G, Benedetti G, Chilovi F, Costan F,De Berardinis F, De Bernardin M, Ederle A, Fina P, Fratton A. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study [J]. Gastrointest En dosc,1998; 48(1):1 -10.
5. ［5］Smithline A, Silverman W, Rogers D, Nisi R, Wiersma M,Jamidar P, Hawes R, Lehman G. Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopicsphincterotomy-induced pancreatitis in high-risk patients [J].Gastrointest Endosc, 1993;39(5): 652 - 657.
6. ［6］Sherman S, Earle FD, Bucksot L, Esber E, Pezzi J,Gottlieb K, Lehman G. Does leaving a main pancreatic duct stent in place reduced the incidence of precut biliary sphincterotomy(ES)-induced pancreatitis [J] ? Am J Gastroenterol, 1995;90(9):1 614.
7. ［7］Meyerson SM, Geenen JE, Johnson GK, Catalano MF,Geenen DJ, Schmalz MJ Hogan WJ. Pancreatic duct stenting decreases the incidence of post-ERCP pancreatitis: a prospective randomized study [J]. Gastroenterology, 1998; 114(4):G1 967.
8. ［8］Tarnasky PR, Palesch YY, Cunningham JT, Mauldin PD,Cotton PB, Hawes RH. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction [J]. Gastroenterology, 1998;115(12):1518-1524.
9. ［9］Patel R, Tarnasky PR, Hennessy WS, Hawes RH, Payne KM, Nelles SE, Cunningham JT, Cotton PB. Does stenting after pancreatic sphincterotomy reduced post-ERCP pancreatitis in patients with prior biliary sphincterotomy: preliminary results of a prospective randomized trial [J]. Gastrointest Endosc, 1999; 49(4):80.
10. ［10］Fazel A, Quadri A, Catalano MF, Meyerson SM, Geenen JE. Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study [J]. Gastrointest Endosc,2003; 57(3): 291 -294.
11. ［11］Sherman S, Lehman GA. ERCP and endoscopic sphincterotomy-induced pancreatitis [J].Pancreas,1991;6(2): 350-367.
12. ［12］Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials [J].JAMA, 1995; 273(5): 408-412.

《中國循證醫學雜志》

胰管支架置入術預防內鏡逆行胰膽管造影術后胰腺炎的系統評價

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《中國循證醫學雜志》

胰管支架置入術預防內鏡逆行胰膽管造影術后胰腺炎的系統評價

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