手术与内镜治疗疼痛性慢性胰腺炎:随机试验的系统回顾和元分析》。

IF 1.8 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Digestive Surgery Pub Date : 2024-01-01 Epub Date: 2024-01-08 DOI:10.1159/000535588
Noel Cassar, Paul Cromwell, Sinead Duggan, Charlotte van Veldhuisen, Marja Boermeester, Marc Besselink, Kevin Conlon
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引用次数: 0

摘要

背景:关于慢性胰腺炎(CP)疼痛的最佳治疗方法存在争议:关于疼痛性慢性胰腺炎(CP)的最佳治疗方法存在争议:本荟萃分析旨在确定疼痛性慢性胰腺炎患者手术治疗与内窥镜检查的疗效比较:方法:两位独立审稿人采用 PRISMA 指南对 PubMed、Embase、Web of Science 和 Cochrane 数据库(1995 年以后)中的研究进行了系统回顾和荟萃分析。主要结果是疼痛缓解:在8479项研究中,有三项是随机试验,共涉及199名患者。与内窥镜检查相比,手术治疗与较低的 Izbicki 评分相关,中期(平均差 (MD) 21.46,95% 置信区间 (CI)13.48-29.43,P 结论:手术治疗对疼痛性颅内压增高患者的疗效更佳:与内窥镜治疗相比,疼痛型 CP 患者的手术治疗能更好地控制疼痛,所需的干预措施也更少。
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Surgery versus Endoscopy for the Management of Painful Chronic Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Trials.

Background: Debate exists regarding the optimal treatment for painful chronic pancreatitis (CP). This meta-analysis aims to determine the outcomes of surgical intervention as compared to endoscopy in patients with painful CP.

Methods: A systematic review and meta-analysis including studies from PubMed, Embase, Web of Science, and Cochrane Databases (1995 onwards) was done by two independent reviewers using PRISMA guidelines. Primary outcome was pain relief.

Results: Among 8,479 studies, three were randomized trials, comprising a total of 199 patients. Compared with endoscopy, surgery was associated with a lower Izbicki score, both at medium term (mean difference (MD) 21.46, 95% confidence interval (CI) 13.48-29.43, p < 0.00001) and long term (MD: 17.80, 95% CI: 8.36-27.23, p = 0.0002). A higher proportion of surgical patients had some sort of pain relief compared with those who had endoscopy, both at medium term (72% vs. 46%, RR: 1.51, 95% CI: 1.19-1.90, p = 0.0006) and long term (73% vs. 47%, RR: 1.50, 95% CI: 1.19-1.89, p = 0.0007). Complete pain relief was more common in the surgical group compared to the endoscopy group, both at medium term (33% vs. 17%, RR: 1.97, 95% CI: 1.16-3.36, p = 0.01) and long term (35% vs. 18%, RR: 1.92, 95% CI: 1.15-3.20, p = 0.01). The pooled crossover rate from endoscopy to surgery was 22% (22/99).

Conclusions: Surgical treatment in patients with painful CP leads to better pain control, requiring fewer interventions as compared to endoscopic treatment.

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来源期刊
Digestive Surgery
Digestive Surgery 医学-外科
CiteScore
4.90
自引率
3.70%
发文量
25
审稿时长
3 months
期刊介绍: ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.
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