LC联合ERCP/LCBDE治疗胆囊结石-胆总管结石疗效Meta分析  

Laparoscopic cholecystectomy combined with endoscopic retrograde cholangiopancreatography vs laparoscopic common bile duct exploration in the treatment of concomitant gallstones and common bile ductstones:A meta analysis

作　　者：田开亮[1] 朱立新[1] 谢坤[1] 赵红川[1] 刘付宝[1] 赵义军[1] 耿小平[1] 

机构地区：[1]安徽医科大学第一附属医院器官移植中心,安徽合肥230022

出　　处：《中国实用外科杂志》2013年第10期881-886,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(81172082)

摘　　要：目的评价腹腔镜胆囊切除联合腹腔镜胆总管探查术（Lc＋LcBDE）与内镜下十二指肠乳头括约肌切开取石联合腹腔镜胆囊切除术（ERCP／S＋LC）治疗胆囊结石合并胆总管结石的临床疗效差异。方法通过PubMed、Cochrane图书馆、MEDLINE、EMBase等数据库，查找发表于1998年1月至2012年12月关于对比分析LC＋LCBDE与ERCP／S＋LC治疗胆囊结石并胆总管结石的随机对照试验研究，按照纳入与排除标准选择文献、提取资料、评价质量后，采用RevMan5．0软件进行数据分析。结果共有9篇研究纳入分析，包括1247例病人，其中LC＋LCBDE组570例，ERCP／S＋LC组497例。结果显示：结石清除率、结石残留率、术后总并发症发生率、病死率、术中转开腹率差异无统计学意义[（RR：0．97，95％CI：0．93-1．02，P=O．24）、（OR：O．46，95％CI：0．13～0．62，P=0．23）、（OR：0．89。95％CI：0．63～1.26，P=0．51）、（RD：0．00，95％CI：-0．01—0．02，P=0．54）、（OR：0．71，95％CI：0．45-1．12，P=0．15）]；手术时间、住院时间、住院费用LC＋LCBDE组优于ERCP／S＋LC组。结论LC＋LCBDE与ERCP／S＋LC两种微创术式有效性及安全性无差异，但前者手术时间、住院时间、住院费用优于后者，可能与ERCP／S＋LC分阶段手术有关，需要更多高质量的前瞻性随机对照研究提供更好的证据。Objective To evaluate the clinical effectiveness of LC ＋ LCBDE and ERCP/S ＋ LC in cholecystolithiasis eholedocholithiasis using recta-analysis method. Methods A fully recursive literature search was conducted in MEDLINE, PubMed, EMbase, Cochrane Central Registe of Controlled Trials only in English, comparing LC ＋ LCBDE with ERCP/S＋LC for cholecystolithiasis choledocholithiasis and published from 1998 to 2012 were recruited. Data were extracted and evaluated by two reviewers independently. The quality of the included trials was evaluated. Meta-analyses were conducted using the Cochrane Collaboration＇s ReyMan 5,1 software. Results Nine controlled clinical trials （1247 cases） were included. The results of meta-analysis showed that： there were no significant difference in the stone clearance rate, residual stone rate, complications morbidity, mortality, cross over to other procedure between the two group [（RR：0.97, 95% CI： 0.93-1.02, P=0.24）, （OR：0.46, 95% CI： 0.13-0.62, P=0.23）, （OR：0.89, 95% CI： 0.63- 1.26,P=0.51）, （RD：0.00, 95% CI： -0.01-0.02, P=0.54）, （OR：0.71, 95% CI： 0.45-1.12, P=0.15）]; the length of hospital stay, procedure time and total hospital charges in the LC ＋ LCBDE group were superior to the ERCP/S ＋ LC group. Conclusion Although there aren＇t differences in the effectiveness and safety between the ERCP/S＋LC group and the LC＋LCBDE group, the latter is superior to the former in procedure time, length of hospital stay and total hospital charges, which might be associated with ERCP/S＋LC surgery in stages. It needs more prospective randomized controlled studieswith high quality to provide better evidences.

关 键 词：胆囊结石 胆总管结石 腹腔镜胆总管探查 括约肌切开术 Meta分析 

分 类 号：R6[医药卫生—外科学]