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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) ›› 2022, Vol. 12 ›› Issue (06) : 361 -366. doi: 10.3877/cma.j.issn.2095-2015.2022.06.008

循证医学

超声内镜引流治疗胰腺手术后胰周积液的系统回顾和Meta分析
范爱娟1, 牟海萍1,†()   
  1. 1. 250021　济南市槐荫人民医院超声科
  • 收稿日期:2022-09-09 出版日期:2022-12-01
  • 通信作者: 牟海萍

Systematic review and Meta-analysis of endoscopic ultrasound drainage for peripancreatic fluid collection after pancreatic surgery

Aijuan Fan1, Haiping Mou1,†()   

  1. 1. Department of Ultrasound, Huaiyin People′s Hospital of Jinan, Jinan 250021, China
  • Received:2022-09-09 Published:2022-12-01
  • Corresponding author: Haiping Mou
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范爱娟, 牟海萍. 超声内镜引流治疗胰腺手术后胰周积液的系统回顾和Meta分析[J/OL]. 中华消化病与影像杂志(电子版), 2022, 12(06): 361-366.

Aijuan Fan, Haiping Mou. Systematic review and Meta-analysis of endoscopic ultrasound drainage for peripancreatic fluid collection after pancreatic surgery[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2022, 12(06): 361-366.

目的

系统评估超声内镜引导引流(EUSD)治疗胰腺手术后胰周积液(PFC)的效果。

方法

检索中英文数据中EUSD和经皮穿刺引流术(PCD)治疗PFC的文献，质量评价后进行Meta分析，比较EUSD和PCD对PFC患者操作成功率、临床成功率、并发症发生率、住院时间、复发率的影响。

结果

共纳入7篇回顾性队列研究，文献NOS得分7分1篇，8分2篇，9分4篇。Meta分析显示EUSD和PCD治疗PFC的操作成功率(OR 0.92，95% CI 0.92~4.72，P＝0.92)、临床成功率(OR 1.52，95% CI 0.79~2.92，P＝0.21)、并发症发生率(OR 0.59，95% CI 0.26~1.36，P＝0.22)、复发率(OR 1.00，95% CI 0.36~2.73，P＝1.00)相比较差异均无统计学意义。EUSD治疗PFC的住院时间低于PCD(MD－2.80，95% CI－5.50~－0.07，P＝0.04)。

结论

与PCD相比较，EUSD治疗胰腺手术后PFC具有类似的操作成功率、临床有效率、并发症发生率和复发率，且可减少住院时间，是治疗PFC安全可行的方法。

关键词: 胰周液体积聚, 超声内镜, 引流, 经皮引流, 荟萃分析
Objective

To systematically evaluate the efficacy of endoscopic ultrasound-guided drainage(EUSD)in the treatment of peripancreatic fluid collection(PFC)after pancreatic surgery.

Methods

The literatures on the treatment of PFC with EUSD and percutaneous puncture drainage(PCD)in Chinese and English were retrieved.After quality evaluation, meta-analysis was conducted to compare the effects of EUSD and PCD on the operation success rate, clinical success rate, complication rate, hospitalization time and recurrence rate of PFC patients.

Results

A total of 7 retrospective cohort studies were included, including 1 article with 7 NOS points, 2 articles with 8 points and 4 articles with 9 points.Meta analysis showed that there were no statistically significant differences in the operation success rate(OR=0.92, 95% CI: 0.92-4.72, P=0.92), clinical success rate(OR=1.52, 95% CI: 0.79-2.92, P=0.21), complication rate(OR=0.59, 95% CI: 0.26-1.36, P=0.22)and recurrence rate(OR=1.00, 95% CI: 0.36-2.73, P=1.00)between EUSD and PCD in the treatment of PFC.The hospitalization time of PFC treated with EUSD was shorter than that treated with PCD(MD=-2.80, 95% CI: -5.50--0.07, P=0.04).

Conclusion

Compared with PCD, EUSD has similar operation success rate, clinical effective rate, complication rate and recurrence rate in the treatment of PFC after pancreatic surgery, and can reduce the hospitalization time.It is a safe and feasible method for the treatment of PFC.

Key words: Peripancreatic fluid collection, Endoscopic ultrasound, Drainage, Percutaneous drainage, Meta analysis
图1 文献纳入流程图
表1 纳入研究的7篇文献特征
作者 发表时间 研究类型 病例数 男性/女性(例)
EUSD PCD EUSD PCD
Al Efishat[10] 2019 回顾性队列 39 39 20/19 20/19
Azeem[11] 2012 回顾性队列 15 33 8/7 14/19
Futagawa[12] 2017 回顾性队列 12 21 5/7 17/4
Jürgensen[13] 2018 回顾性队列 39 59 20/19 29/30
Kwon[14] 2013 回顾性队列 12 14 4/8 5/9
Onodera[15] 2012 回顾性队列 6 18 6/0 11/7
Tamura[16] 2019 回顾性队列 13 28 10/3 16/12
作者 年龄(岁) 手术类型(例) 胰周液体积聚直径(cm)
EUSD PCD 远端胰腺切除 胰十二指肠切除 中段胰腺切除术 其他 EUSD PCD
Al Efishat[10] 53(17~85) 53(21~82) 48 20 6 4 NR NR
Azeem[11] 63(39~75) 65(43~83) 48 0 0 0 7(4~19) 6.4(2.8~16)
Futagawa[12] 60(55~69) 66(59~74) 18 13 2 0 8.0 9.0
Jürgensen[13] 62.1 55.6 NR NR NR NR 4(1~12) 7(5~9)
Kwon[14] 67.8 66.9 21 NR NR NR 8.9 10.9
Onodera[15] 64.2±12.0 67.0±8.3 6 18 0 0 4.9(0.6~7.7) 7(3~14.7)
Tamura[16] 53(17~85) 53(21~82) 23 18 0 0 7.53±1.96 7.26±2.36
表2 纳入研究的7篇文献NOS评分结果(分)
作者 选择 可比性C 结局 NOS评分
S1 S2 S3 S4 E1 E2 E3
Al Efishat[10] 1 1 1 1 2 1 0 1 8
Azeem[11] 1 1 1 1 2 1 1 1 9
Futagawa[12] 1 1 1 1 2 1 0 0 7
Jürgensen[13] 1 1 1 1 2 1 0 1 8
Kwon[14] 1 1 1 1 2 1 1 1 9
Onodera[15] 1 1 1 1 2 1 1 1 9
Tamura[16] 1 1 1 1 2 1 1 1 9
图2 EUSD和PCD治疗PFC操作成功率的森林图注：PFC胰周液体积聚；PCD经皮穿刺引流术；EUSD超声内镜引导引流术
图3 EUSD和PCD治疗PFC临床成功率的森林图注：PFC胰周液体积聚；PCD经皮穿刺引流术；EUSD超声内镜引导引流术
图4 EUSD和PCD治疗PFC并发症发生率的森林图注：PFC胰周液体积聚；PCD经皮穿刺引流术；EUSD超声内镜引导引流术
图5 EUSD和PCD治疗PFC住院时间的森林图注：PFC胰周液体积聚；PCD经皮穿刺引流术；EUSD超声内镜引导引流术
图6 EUSD和PCD治疗PFC复发率的森林图注：PFC胰周液体积聚；PCD经皮穿刺引流术；EUSD超声内镜引导引流术
图7 EUSD和PCD治疗PFC临床成功率的倒漏斗图注：PFC胰周液体积聚；PCD经皮穿刺引流术；EUSD超声内镜引导引流术
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