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目的评价直肠使用吲哚美辛栓剂预防内镜逆行胰胆管造影取石术后胰腺炎(PEP)的临床疗效,并评估不同时段给药对临床疗效的影响。方法检索PubMed、Web of Science、Cochrane图书馆、中国期刊全文数据库(CNKI)、中国生物医学文献数据库、维普、万方等数据库,并手工检索相关文献,收集直肠使用吲哚美辛栓剂预防PEP的随机对照试验,检索时间从2000年至2016年10月。以PEP发生率、出血并发症发生率为评价指标,采用Jadad评分法进行质量评估,采用Rev Man 5.3软件进行Meta分析。结果纳入符合标准的随机对照试验18项,共4 923例患者,吲哚美辛组PEP发生率低于对照组(RR=0.50,95%CI:0.42~0.60,P<0.000 01)。按不同给药时段的亚组分析中,T2组(术前0.5~1 h)、T3组(术前1~2 h)、T4组(术后0.5 h内)和T5组(术后0.5~2 h)PEP发生率均较对照组降低(分别为RR=0.38,95%CI:0.24~0.62,P<0.000 1;RR=0.43,95%CI:0.29~0.62,P<0.000 01;RR=0.52,95%CI:0.3 7~0.71,P<0.0 00 1;RR=0.39,95%CI:0.23~0.65,P=0.000 3)。T1组(术前0.5 h内)和T6组(术中给药)与对照组PEP发生率无显著差异(均P>0.05)。吲哚美辛组与对照组的出血并发症发生率无显著差异(P>0.05)。结论吲哚美辛栓剂能有效预防PEP,术前0.5~2 h和术后给药吲哚美辛均能减少PEP的发生,而无出血并发症风险的增加。
Objective To evaluate the clinical efficacy of indometacin suppository in the treatment of pancreatitis after endoscopic retrograde cholangiopancreatography (PEP) and to evaluate the effect of different periods of time on clinical curative effect. Methods The databases of PubMed, Web of Science, Cochrane Library, CNKI, Biomedical Literature Database of China, VIP, Wanfang and so on were searched. Relevant literatures were searched manually and indometacin suppository was collected for rectal prophylaxis of PEP Randomized controlled trials, retrieved from 2000 to October 2016. The incidence of PEP and the incidence of bleeding complication were used as the evaluation indexes, and the quality was evaluated by Jadad score method. Meta-analysis was performed by Rev Man 5.3 software. Results A total of 18 RCTs were included in the study. A total of 4 923 patients were enrolled. The incidence of PEP in indometacin group was lower than that in control group (RR = 0.50, 95% CI: 0.42-0.60, P <0.000 01). According to the subgroup analysis of different administration periods, T2 (preoperative 0.5 ~ 1 h), T3 (preoperative 1 ~ 2 h), T4 (postoperative 0.5 h) and T5 (postoperative 0.5 ~ P <0.0001; RR = 0.43, 95% CI: 0.29-0.62, P <0.000 01; RR = 0.38, P < 0.52, 95% CI: 0.3 7 ~ 0.71, P <0.0 00 1; RR = 0.39, 95% CI: 0.23-0.65, P = 0.0003). The incidence of PEP in T1 group (within 0.5 h before operation) and T6 group (intraoperative administration) and control group had no significant difference (all P> 0.05). There was no significant difference in the incidence of bleeding complications between indometacin group and control group (P> 0.05). Conclusions Indometacin suppository can effectively prevent PEP. 0.5 ~ 2 h preoperative and postoperative administration of indomethacin can reduce the occurrence of PEP without an increased risk of bleeding complications.