• 四川大學(xué)華西醫(yī)院消化內(nèi)科,成都,610041;

目的 　評(píng)價(jià)胰管支架置入術(shù)能否降低內(nèi)鏡逆行胰膽管造影(endoscopic retryrade cholangio pancreatograph,ERCP)術(shù)后胰腺炎(post-ERCP pancredtitis,PEP)高危患者PEP的發(fā)生率、嚴(yán)重程度及其臨床應(yīng)用的安全性.
方法 　計(jì)算機(jī)檢索Cochrane上消化道和胰腺專(zhuān)業(yè)臨床試驗(yàn)資料庫(kù)(2004年第1期)、Cochrane臨床對(duì)照試驗(yàn)資料庫(kù)(2004年第1期、MEDLINE(1966-2004.4)、EMBASE(1985～2004.4)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(1970～2004.4)以及中國(guó)循證醫(yī)學(xué)中心隨機(jī)對(duì)照試驗(yàn)資料庫(kù),手工檢索8種相關(guān)中文期刊及所獲文獻(xiàn)的參考文獻(xiàn),全面收集全世界關(guān)于胰管支架置入術(shù)預(yù)防PEP的臨床隨機(jī)對(duì)照試驗(yàn),并按Cochrane協(xié)作網(wǎng)推薦的方法進(jìn)行系統(tǒng)評(píng)價(jià).
結(jié)果 　共6篇RCT包括468例PEP高?；颊弑患{入評(píng)價(jià).Meta分析結(jié)果顯示,胰管支架置入術(shù)可降低PEP高危患者PEP的發(fā)生率[Peto RR 0 31,95 CI(0.19,0.52);P＜0.000 01;NNT=6]及重度PEP的發(fā)生率[Peto OR0.13,95％CI(0.04,0.47);P=0.002;NNT=24].上述結(jié)果均與敏感性分析的結(jié)果一致.
結(jié)論 　胰管支架置入術(shù)可降低PEP高?；颊逷EP的發(fā)生率和重度PEP的發(fā)生率,可能是預(yù)防PEP的有效方法.但由于能夠納入系統(tǒng)評(píng)價(jià)的試驗(yàn)有限且存在方法學(xué)上的局限性,尚需謹(jǐn)慎地看待這一結(jié)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(shù)預(yù)防內(nèi)鏡逆行胰膽管造影術(shù)后胰腺炎的系統(tǒng)評(píng)價(jià). 中國(guó)循證醫(yī)學(xué)雜志, 2004, 04(10): 693-699. doi: 復(fù)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. ［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. ［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. ［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. ［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. ［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. ［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. ［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. ［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. ［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. ［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. ［11］Sherman S, Lehman GA. ERCP and endoscopic sphincterotomy-induced pancreatitis [J].Pancreas,1991;6(2): 350-367.
  12. 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.