腹腔镜联合胆道镜钬激光与开腹手术治疗胆管结石疗效比较的Meta分析  

Combined Treatment of Laparoscopy and Choledochoscope-Aided Holmium Laser vs.Open Surgery for Cholangiolithiasis: A Meta-Analysis

作　　者：刘清[1] 金俊哲[1] 许东[1] 姜洪磊[1] 于浩[1] 林国福[1] LIU Qing JIN Jun-zhe XU Dong JIANG Hong-lei YU Hao LIN Guo-fu(Department of General Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China)

机构地区：[1]中国医科大学附属第四医院普外科,沈阳市110032

出　　处：《中国激光医学杂志》2017年第3期137-142,共6页Chinese Journal of Laser Medicine & Surgery

摘　　要：目的系统评价腹腔镜联合胆道镜钬激光治疗胆管结石的有效性及安全性。方法计算机检索PubM ed、Web of science、Cochrane图书馆、CNKI、VIP和万方数据库,并辅以其他检索,收集2013年1月至2016年9月期间发表的关于腹腔镜联合胆道镜钬激光(腹腔镜组)与开腹手术(开腹组)治疗胆管结石疗效对比的文献,按纳入标准筛选文献、提取资料并进行质量评价后,利用Review Manager 5.3软件进行Meta分析。结果未获得随机对照试验,最终共纳入13篇病例对照研究,共1 194例患者,其中腹腔镜组(Laparoscopy group,LAP)598例,开腹组(Open group,OPEN)596例。Meta分析结果显示:(1)手术时间:腹腔镜组短于开腹组,差异有统计学意义(P<0.0001);(2)术中出血量:腹腔镜组少于开腹组,差异有统计学意义(P<0.0001);(3)结石取净率:腹腔镜组高于开腹组,差异有统计学意义(P<0.0001);(4)住院时间:腹腔镜组短于开腹组,差异有统计学意义(P<0.0001);(5)术后并发症发生率:腹腔镜组低于开腹组,差异有统计学意义(P<0.0001)。结论腹腔镜联合胆道镜钬激光应用于胆管结石治疗在疗效和安全性方面均优于开腹手术,值得临床广泛开展。因本系统评价纳入的均为非随机对照实验,且均为中文文献,结论解释范围和强度较局限,尚需大样本多中心高质量随机对照试验(Randomized controlled trial,RCT)进一步验证。Objective To systematicallyevaluatethe efficacy and safety of combined application of laparoscopy andcholedochoscope - aidedholmium laser therapy for cholangiolithiasis. Methods To collect the literatures on the comparison of combined application （Laparoscopy group, LAP） of laparoscopy and choledo- choscope-aided holmium laser therapyand open surgery（ Open group, OPEN） for cholangiolithiasis published from Jan. 2013 to Sep. 2016, PubMed, Web of Science, Cochrane Library, CNKI, VIP, Wanfang Databaseand other sources available were searched. After screening for inclusion, data extractionand quality assessment, a Meta-analysis was conducted with Review Manager 5.3 software. Results Thirteen case-controlled studies were finally included,involving 1 194 cases （598 cases in the LAP group and 596 cases in the OPEN group）. Compared with the OPEN group, the LAP group had a shorter operation time（P 〈0. 0001 ） and hospital stay（P 〈 O. 0001 ）, less intraoperative blood loss （P 〈 0. 0001 ）, a higher stone-cleaned rate （ P 〈 0. 0001 ） anda lower postoperative complica- tions rate（ P 〈 0. 0001 ）. Conclusions In both efficacy and safety, combined application of laparoscopy andcholedochoscope-aided holmium laser therapy for cholangiolithiasisis significantly better than open surgery. Further larger and multicenter studies are expected to validate our findings.

关 键 词：腹腔镜 胆道镜 钬激光 胆管结石 META分析 

分 类 号：R454.2[医药卫生—治疗学] R657.42[医药卫生—临床医学]