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目的系统评价腹腔镜Heller手术与内镜下球囊扩张术治疗贲门失弛缓症的临床安全性和疗效。方法计算机检索PubMed、EMbase、The Cochrane Library(2015年8期)、Web of Knowledge、CBM、CNKI、VIP和WanFang Data,搜集腹腔镜Heller手术与内镜下球囊扩张术治疗贲门失弛缓症的相关随机对照试验(RCT),检索时限均为从建库至2015年8月26日。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入5个RCT,包括446例患者。Meta分析结果显示:与内镜下球囊扩张术治疗贲门失弛缓症相比,腹腔镜Heller手术可提高治疗后3个月有效率[OR=2.66,95%CI(1.08,6.60),P=0.03]和1年有效率[OR=2.24,95%CI(1.29,3.87),P=0.004],但在治疗后2~3年有效率[OR=1.749,95%CI(0.99,3.23),P=0.05]和并发症发生率[OR=0.27,95%CI(0.06,1.13),P=0.07]方面,二者差异无统计学意义。结论现有证据表明,与内镜下球囊扩张术相比,腹腔镜Heller手术治疗贲门失弛缓症可以提高治疗后短期(3个月及1年)有效率,但两种治疗方式在治疗2年以上的有效率及并发症发生率方面无显著差异。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。
Objective To evaluate the clinical efficacy and safety of laparoscopic Heller and endoscopic balloon dilatation in the treatment of achalasia. Methods PubMed, EMbase, The Cochrane Library (2015, 8), Web of Knowledge, CBM, CNKI, VIP and WanFang Data were collected. The correlation between laparoscopic Heller surgery and endoscopic balloon dilatation in the treatment of achalasia was collected. Randomized controlled trial (RCT), search time from the database to August 26, 2015. Two researchers independently screened the literature, extracted data, and assessed the risk of being included in the study. Meta-analysis was performed using RevMan 5.3 software. Results A total of 5 RCTs were included, including 446 patients. Meta-analysis showed that laparoscopic Heller surgery improved the effective rate at 3 months after endoscopic balloon dilatation (OR = 2.66, 95% CI 1.08, 6.60, P = 0.03], and 1 year (OR = 2.24, 95% CI 1.29, 3.87, P = 0.004), but with an effective rate of 2 to 3 years after treatment P = 0.05] and the incidence of complications [OR = 0.27,95% CI (0.06,1.13), P = 0.07]. There was no significant difference between the two groups. Conclusions The evidence available suggests that laparoscopic Heller for the treatment of achalasia may improve short-term (3 months and 1 year) efficacy after endoscopic balloon dilatation compared with endoscopic balloon dilation, There was no significant difference in the effective rate and the complication rate between years. Subject to the number of studies and quality constraints, the above conclusion still needs more high-quality research to be verified.