李维++++++于红刚++++++慕刚刚

[摘要] 目的 系统评价术后预防性放置鼻胆管引流术（ENBD）对经内镜逆行胰胆管造影术后胰腺炎（PEP）及高淀粉酶血症的有效性及安全性。 方法 计算机检索PubMed、Medline、EMBASE、CBM、CNKI及WanFang Data，检索时限从建库至2014年2月24日，全面收集ENBD预防PEP的随机对照试验。由2位评价者按照纳入和排除标准独立选择文献、提取资料和评价质量后，采用RevMan 5.2软件进行Meta分析。 结果 共纳入14个临床对照研究，3143例拟行ERCP术的患者。Meta分析结果显示：观察组和对照组术后PEP发生率比较差异有统计学意义[OR = 0.25，95%CI：0.17～0.36，P < 0.000 01]，两组术后24 h血清淀粉酶水平比较差异有统计学意义[OR = 0.33，95%CI：0.23～0.46，P < 0.000 01]，内镜下鼻胆管引流术能减少术后胰腺炎和高淀粉酶血症的发生率。 结论 术后预防性放置鼻胆管引流可以有效降低ERCP术后胰腺炎及高淀粉酶血症的发生率。但因原始研究的质量限制，需要更多大样本、高质量、设计严谨的随机对照试验论证以上结论。

[关键词] 内镜下鼻胆管引流；内镜下逆行性胰胆管造影；Meta分析

[中图分类号] R572.2 [文献标识码] A [文章编号] 1673-7210（2014）10（a）-0043-05

Endoscopic nasobiliary drainage for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasemia： a Meta-analysis

LI Wei YU Honggang MU Ganggang

Department of Gastroenterology， Renmin Hospital of Wuhan University， Hubei Province， Wuhan 430060， China

[Abstract] Objective To systematically review the effectiveness and safety of endoscopic nasobiliary drainage in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis （PEP） and hyperamylasemia. Methods Electronic searches were conducted to connect randomized controlled trials comparing ENBD to placebo in the prevention of PEP from the PubMed， Medline， EMBASE， CBM， CNKI and WanFang Data. All ISI were searched from their establishment to February 24， 2014. According to the inclusion and exclusion criteria， literature identification， data extraction， and quality assessment were performed by two reviewers independently. Then， RevMan 5.2 software was used for Meta-analysis. Results A total of 14 randomized controlled trials involving 3143 patients were included. The Meta-analysis showed that incidence of PEP between obsenvation group and control group was statistically significant （OR = 0.11， 95%CI： 0.05-0.27， P < 0.000 01）， incidence of hyperamylasemia was statistically significant （OR = 0.27， 95%CI： 0.18-0.42， P < 0.000 01）. Endoscopic nasobiliary drainage could reduce the incidence of PEP and hyperamylasemia. Conclusion ENBD is safe and effective in reducing the incidence of PEP and hyperamylasemia. Due to the limitation of quality of the original studies， this consequence has to be confirmed by more large scale， high quality and rigorously designed of randomized controlled trials.

[Key words] Endoscopic nasobiliary drainage； Endoscopic retrograde cholangiopancreatography； Meta-analysis

内镜下逆行性胰胆管造影（ERCP）可直接提供胆汁和胰腺导管的清晰图像，是诊治胰胆管疾病重要的手段。随着ERCP技术的成熟，术后并发症的发生率明显减少，但ERCP术后胰腺炎（PEP）仍是ERCP术后最常见、最严重的并发症[1]。术后高淀粉酶血症的发生率也高达75%[2]其中约有10%可发展为重症胰腺炎，导致不良后果。临床发现，PEP的发生多与ERCP引起的乳头水肿或Oddi括约肌痉挛所致的胰管引流障碍相关，术后放置鼻胆引流管可以避免PEP的发生。本研究搜集内镜下鼻胆管引流预防PEP的前瞻性研究并进行Meta分析，以评价鼻胆管引流的有效性和安全性，为临床应用提供参考。

1 资料与方法

1.1 文献纳入与排除标准

遵照“PICOS”原则[3]，本Meta分析的纳入标准为：①研究对象：拟行ERCP术且具备适应证的患者。②干预措施：观察组术后采用预防性使用鼻胆管引流术，对照组采用空白对照。……