■大多数胰腺胰岛素瘤可以通过微创方式进行治疗。这项荟萃分析的目的是评估内镜超声(EUS)引导消融和微创手术(MIS)治疗胰腺胰岛素瘤的临床结果。
■搜索在线数据库以进行相关研究。主要目的是比较不良事件(AE)的发生率,次要目的是比较临床和技术成功率。住院时间,EUS和MIS方法之间的症状复发率。
■共纳入150例患者的8项研究报告了EUS引导消融结果,组成EUS集团,9项研究,236例患者报告了MIS结果,形成MIS组。EUS组中纳入患者的合并中位年龄大于MIS组(64.06vs.44.98岁,p<0.001)。此外,EUS组的技术成功率明显更高(100%vs.96.6%,p=0.025),而MIS组的临床成功率明显更高(6%)(94%vs.98.7%,p=0.021)。不良事件发生率(18.7%与31.1%,p=0.012)和严重不良事件发生率(1.3%vs.7.9%,p=0.011)在EUS组中显着更低。EUS组的住院时间中位数(2.68天,95%CI:1.88-3.48,I2=60.3%)显著短于MIS组(7.40天,95%CI:6.22-8.58,I2=42.2%,p<0.001)。EUS组的复发率明显更高(15.3%vs.1.3%,p<0.001)。
■EUS引导的消融与较低的AE率和较短的住院时间相关,但与MIS相比,胰岛素瘤的治疗复发率更高。EUS方法可能是一种替代方法,即使是一线,对不良手术候选人的治疗。
UNASSIGNED: Most pancreatic insulinomas can be treated by minimally invasive modalities. The aim of this meta-analysis was to assess the clinical outcomes of endoscopic ultrasound (EUS)-guided ablation and minimally invasive surgery (MIS) in the treatment of pancreatic
insulinoma.
UNASSIGNED: Online databases were searched for relevant studies. The primary aim was to compare the rates of adverse events (AEs) and the secondary aims were to compare the clinical and technical success rates, length of hospital stays, and symptom recurrence rates between EUS and MIS approaches.
UNASSIGNED: Eight studies with 150 patients were identified that reported EUS-guided ablation outcomes, forming the EUS group, and 9 studies with 236 patients reported MIS outcomes, forming the MIS group. The pooled median age of the included patients in the EUS group was greater than that of the MIS group (64.06 vs. 44.98 years old, p < 0.001). Also, the technical success rate was significantly higher in the EUS group (100% vs. 96.6%, p = 0.025), while the clinical success was significantly higher (6%) in the MIS group (94% vs. 98.7%, p = 0.021). The AE rates (18.7% vs. 31.1%, p = 0.012) and severe AE rates (1.3% vs. 7.9%, p = 0.011) were significantly lower in the EUS group. The median length of hospital stay in the EUS group (2.68 days, 95% CI: 1.88-3.48, I2 = 60.3%) was significantly shorter than in the MIS group (7.40 days, 95% CI: 6.22-8.58, I2 = 42.2%, p < 0.001). The recurrence rate was significantly higher in the EUS group (15.3% vs. 1.3%, p < 0.001).
UNASSIGNED: EUS-guided ablation is associated with a lower AE rate and a shorter length of hospital stay, but a higher recurrence rate for the treatment of
insulinoma compared with MIS. The EUS approach may be an alternative, even first-line, treatment for poor surgery candidates.