摘要：
Objective To assess the effectiveness and safety of indomethacin in preventing post-endoscopic retrograd cholangiopancreatography pancreatitis (PEP) by rectal administration.Methods Retrieved from PubMed,Cochrane Library,CNKI,VIP,CBM and Wanfang database,randomized blinding placebo-controlled trails about indomethacin for preventing PEP by rectal administration were included from establishment to December 2017 and comprehensively evaluated.Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data,assessed the risk bias of included studies,and then Meta-analysis was performed using the RevMan 5.3 software.Results A total of 8 RCTs involving 3240 patients were included.The results of Meta-analysis showed that indomethacin could reduce the incidence of PEP(OR =0.57,95％ CI:0.45-0.73,P ＜ 0.00 001) and moderate or severe PEP(OR =0.51,95 ％ CI:0.30-0.85,P =0.010).The adverse reactions of i ndomethacin was gastrointestinal bleeding,and there was no statistically significant difference between indomethacin and placebo(OR =0.63,95％ CI:0.25-1.52,P =0.300).Conclusion Indomethacin is safe and effective in reducing the incidence of PEP by rectal administration.%目的 评价吲哚美辛直肠给药预防经内镜逆行胰胆管造影术(ERCP)后胰腺炎(post-ERCP pancreatitis,PEP)的有效性和安全性.方法 计算机检索PubMed、Cochrane图书馆、中国期刊全文数据库(CNKI)、维普中文科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)、万方数据等数据库公开发表的吲哚美辛直肠给药预防ERCP术后胰腺炎的随机对照试验,检索年限均为自建库至2017年12月.由2位研究者按照纳入与排除标准筛选文献、提取资料和评价纳入研究偏倚风险后,采用RevMan 5.3统计软件进行Meta分析.结果 共纳入8项研究,合计3 240例患者.Meta分析结果显示:应用吲哚美辛直肠给药可显著降低PEP的发生率(OR =0.57,95％ Cl:0.45 ～ 0.73,P＜0.00 001)及中重度PEP发生率(OR =0.51,95％Cl:O.30～0.85,P=0.010);其引起的主要不良反应为胃肠道出血,但与安慰剂组比较差异无统计学意义(OR=0.63,95％ Cl:0.25～ 1.52,P=0.300).结论 吲哚美辛直肠给药能够有效降低ERCP术后胰腺炎的发生率,且无严重不良反应.
