胆囊结石合并胆总管结石两种微创术式比较的Meta分析  

A meta-analysis to compare LC＋LCBDE with ERCP＋LC for patients with concomitant gallstones and common bile duct stones

作　　者：陈超波[1] 仇毓东[2] 顾盐炎 蔡浩[2] 

机构地区：[1]南京大学医学院研究生班江苏省无锡市锡山人民医院普外科,210008 [2]南京大学医学院附属鼓楼医院肝胆外科 [3]无锡市锡山人民医院普外科

出　　处：《中华肝胆外科杂志》2013年第10期752-757,共6页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的对腹腔镜胆囊切除联合胆总管探查取石（LC＋LCBDE）与内镜逆行胰胆管造影／内镜下括约肌切开取石术（EST）联合腹腔镜胆囊切除术（ERCP／EST＋LC）治疗胆囊结石合并胆总管结石的有效性及安全性进行比较。方法在Pubmed、EMBASE、中国知网数据库中检索1990至2013年3月发表的比较LC＋LCBDE和ERCP／EST＋LC疗效的随机对照研究，并应用Revman5．1进行Meta分析。分析的主要内容为结石清除率、并发症发生率、手术时间和住院时间。结果9项研究最终入选，包括1021例患者。Meta分析提示，LC＋LCBDE和ERCP／EST＋LC在结石清除率（OR1．55，95％C10．95～2．52，P=0．08）、并发症发生率（OR1．12，95％C10．75～1．67，P-0．58）、手术时间（WMD-54．44，95％CI-107．7～-1．17，P-0．05）及住院时间（WMD-0．22，95％CI-2．6～2．16，P-0．86）方面的差异无统计学意义。结石清除率Meta分析的P值随着纳入文献的增多，逐渐接近0．05。因为样本量较小，手术时间的Meta分析也未得出明显差异。结论LC＋LCBDE和ERCP／EST＋LC具有相似的结石清除率和并发症发生率，并且在手术时间及住院时间方面两者也无明显差异。但随着研究样本量的增大，LC＋LCBDE在结石清除率和手术时间方面的优越性将会凸显。Objective To compare the safety and efficiency of laparoscopic cholecystectomy （LC） ＋ laparoscopic common bile duct exploration （LCBDE） with endoscopic retrograde cholangiopancreatography （ERCP） /endoscopic sphincterotomy （EST） ＋LC for patients with concomitant gallstones and common bile duct stones. Methods The Pubmed, EMBASE and CNKI were searched for randomized controlled trials published from 1990 to March, 2012. Revman 5.1 was used to perform the meta-analysis. The main outcomes were stone clearance rate, treatment morbidity, operative time and length of hospital stay. Results 9 studies with 1021 patients were included into the final analysis. Meta-analysis demonstrated that LC＋LCBDE was similar to ERCP/EST＋LC in the stone clearance rate （OR 1.55, 95%C1 0.95-2.52, P=0.08）, treatment morbidity （OR 1.12, 95%CI 0.75 1.67, P=0.58）, operative time （WMD --54.44, 95%CI --107.7%-1.17, P=0.05） and length of hospital stay （WMD --0. 22, 95%CI --2. 6-2.16, P=0.86）. The P value of the stone clearance rate was approaching 0.05 with increased number of studies in the analysis. There was no significant difference in the operative time, probably because of small sample size. Cunclusiuns LC＋ LCBDE was equivalent to ERCP/EST＋ LC in stone clearance rate, treatment morbidity, operative time and length of hospital stay. There is a possibility that LC＋LCBDE can be superior to ERCP/EST＋LC in the stone clearance rate and the operative time with increase in sample size.

关 键 词：胆结石 胆囊切除术 腹腔镜 胰胆管造影术 内窥镜逆行 META分析 

分 类 号：R657.4[医药卫生—外科学]