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中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2018, Vol. 08 ›› Issue (04) : 158 -162. doi: 10.3877/cma.j.issn.2095-2015.2018.04.004

所属专题： 文献；

循证医学

钛夹预防消化内镜术后并发症的Meta分析
袁明亮1, 季万胜2, 董静武1, 余学春1, 伏玲1, 张永琪1, 高志星2,†()   
  1. 1. 211700　江苏省，盱眙人民医院消化内科
    2. 261031　山东省，潍坊医学院附属医院消化内科
  • 收稿日期:2018-01-26 出版日期:2018-08-01
  • 通信作者: 高志星

Clips prevent postoperative complications of gastrointestinal endoscopy: a Meta-analysis

Mingliang Yuan1, Wansheng Ji2, Jingwu Dong1, Xuechun Yu1, Ling Fu1, Yongqi Zhang1, Zhixing Gao2,†()   

  1. 1. Department of Gastroenterology, Xuyi People′s Hospital, Huaian 211700, China
    2. Department of Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang 261031, China
  • Received:2018-01-26 Published:2018-08-01
  • Corresponding author: Zhixing Gao
  • About author:
    Corresponding author: Gao Zhixing, Email:
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引用本文：

袁明亮, 季万胜, 董静武, 余学春, 伏玲, 张永琪, 高志星. 钛夹预防消化内镜术后并发症的Meta分析[J]. 中华消化病与影像杂志(电子版), 2018, 08(04): 158-162.

Mingliang Yuan, Wansheng Ji, Jingwu Dong, Xuechun Yu, Ling Fu, Yongqi Zhang, Zhixing Gao. Clips prevent postoperative complications of gastrointestinal endoscopy: a Meta-analysis[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2018, 08(04): 158-162.

目的

评价使用钛夹关闭内镜下黏膜切除术(endoscopic mucosal resection，EMR)、内镜下黏膜剥离术(endoscopic submucosal dissection，ESD)等术后创面减少术后迟发性出血以及促进创面愈合的有效性。

方法

计算机检索2017年10月之前PubMed、EMBASE、Cochrance library三个数据库中公开发表的有关钛夹关闭EMR、ESD术后创面的文献，依据纳入和排除标准将最终入选的文献应用Review Manager 5.3软件分析数据。

结果

最终6篇随机对照试验文献纳入研究。Meta分析结果显示：钛夹关闭创面不能减少术后迟发性出血的发生率(OR＝0.43，95% CI：0.14～1.29，P＝0.13)，差异无统计学意义；然而创面关闭可以促进创面愈合(OR＝－1.18，95% CI：－1.77～－0.60，P<0.01)，差异有统计学意义。

结论

钛夹关闭创面不能减少EMR、ESD等术后迟发性出血的发生，但可能促进医源性创面的愈合。

关键词: 钛夹, 内镜下黏膜切除术, 内镜下黏膜剥离术, 迟发性出血, Meta分析
Objective

To assess the effectiveness of using Clip closure of defect after endoscopic mucosal resection(EMR), endoscopic submucosal dissection(ESD)and others to reduce the rate of delayed postoperative bleeding and accelerate wound healing.

Methods

Papers published before October 2017 in PubMed、EMBase and Cochrance library about using Clip closure of defect after EMR, ESD were obtained by computer retrieval.Meta-analysis for each outcome of the included studies that were identified by the inclusion criteria and the exclusion criteria was conducted using software Review Manager 5.3.

Results

Finally a total of six randomized controlled trial studies were included.Meta-analysis showed that Clip closure of defect after endoscopic surgery did not reduce the incidence of delayed postoperative bleeding(OR=0.43, 95% CI: 0.14-1.29, P=0.13), and there was no statistically significant difference.But using Clip closure of defect after endoscopic surgery could accelerate wound healing(OR=-1.18, 95% CI: -1.77~-0.60, P<0.01), and the difference was statistically significant.

Conclusion

Using Clip closure of defect after EMR, ESD and others can not reduce the rate of delayed postoperative bleeding but may be able to accelerate wound healing.

Key words: Clip, Endoscopic mucosal resection, Endoscopic submucosal dissection, Delayed postoperative bleeding, Meta-analysis
表1 纳入文献特征表
研究 国家 部位 性别(男∶女) 年龄 手术类型 创面大小 分组 例数 延迟性出血 穿孔 腹痛 电凝综合征 住院天数 4周后创面面积
Shioji等[12] 日本 结直肠 118∶38 64±9 EMR (12.3±4.6) mm2 试验组 205 2 NR NR NR ? NR
130∶37 63±12 ? (12.3±4.9)mm2 对照组 208 2 ? ? ? ? ?
Lee等[13] 韩国 胃 18∶8 63.2±7.8 ESD (4.5～37.7 ) cm2 试验组 26 0 NR NR NR 2－4 NR
19∶7 63.9±6.8 ? (5.9～30.0 )cm2 对照组 26 1 ? ? ? 3－13 ?
Zhang等[14] 中国 结直肠 112∶62 67.9 EMR、ESD、 1～4 cm 试验组 174 2 1 5 1 3.1±0.3 NR
107∶67 64.2 CEMR ? 对照组 174 12 1 29 8 4.7±0.4 ?
Ritsuno等[15] 日本 结直肠 NR NR ESD (670±220) mm2 试验组 14 0 0 NR NR NR 4.3±8.16 mm2
? ? ? (790±312.7)mm2 对照组 14 0 0 ? ? ? 48.5±56.7mm2
Osada等[16] 日本 结直肠 4∶9 68.8±8.7 ESD (677.2±306.3) mm2 试验组 13 0 0 NR NR NR 2.17±4.51 mm2
7∶6 66.2±10.4 ? (790.0±220.6)mm2 对照组 13 0 0 ? ? ? 27.42±25.72mm2
Matsumoto等[17] 日本 结直肠 534∶218 65 EMR <2 cm 试验组 1 636 18 NR NR NR NR NR
513∶234 66 ? ? 对照组 1 729 15 ? ? ? ? ?
表2 文献Jadad评分
文献 随机序列的产生 随机化隐藏 盲法 撤出与退出 总分
Shioji等[12] 1 2 0 1 4
Lee等[13] 1 1 0 1 3
Zhang等[14] 1 2 1 1 5
Ritsuno等[15] 1 2 0 1 4
Osada等[16] 1 2 0 1 4
Matsumoto等[17] 2 2 0 1 5
图1 预防性钛夹关闭黏膜创面对术后迟发性出血的森林图
图2 结直肠中预防性钛夹关闭黏膜创面对术后迟发性出血的森林图
图3 预防性钛夹关闭黏膜创面对术后创面愈合情况的森林图
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