腹腔镜胆总管探查术与内镜下乳头括约肌切开取石术治疗胆总管结石中远期并发症的Meta分析  

The medium and long-term complications of laparoscopic common bile duct exploration versus endoscopic sphincterotomy:a meta-analysis

作　　者：韩洪超[1,2] 王爱坤 王立胜[1] 宋振顺[2] HAN Hong-chao;WANG Ai-kun;WANG Li-sheng(Department of General Surgery,Yancheng Third People s Hospital,Yancheng 224000,China;Shanghai Tenth People’s Hospital,Nanjing Medical University)

机构地区：[1]盐城市第三人民医院,江苏盐城224000 [2]南京医科大学附属上海十院临床医学院

出　　处：《腹腔镜外科杂志》2019年第4期276-280,共5页Journal of Laparoscopic Surgery

摘　　要：目的:评价腹腔镜胆总管探查术(LCBDE)与内镜十二指肠乳头括约肌切开术(EST)治疗胆总管结石的中、远期结石残留率与复发率。方法:检索PubMed、Embase、Cochrane Library、CBM、CNKI及Google Scholar数据库中关于LCBDE与EST治疗胆总管结石疗效比较的随机对照试验(RCT)。根据纳入标准与排除标准,由两名研究员独立进行数据提取并对文献质量进行评价;采用RevMan 5.3软件对两种术式的胆总管结石残留率与复发率进行Meta分析。结果:纳入12篇RCT文献,总样本量为1 414例,其中LCBDE组708例,EST组706例。Meta分析结果显示,两组术后胆总管结石残留率差异无统计学意义(OR=0.48,95%CI:0.23～1.03,P=0.06),术后胆总管结石复发率LCBDE组低于EST组,两组差异有统计学意义(OR=0.32,95%CI:0.19～0.53,P<0.0001)。结论:两种术式的术后结石残留率相近,但LCBDE术后胆总管结石复发率低于EST。Objective: To evaluate the medium and long-term residual rate and recurrence rate of laparoscopic common bile duct exploration (LCBDE) and endoscopic sphincterotomy (EST) in the treatment of choledocholithiasis. Methods: The PubMed,Embase,Cochrane Library,CBM,CNKI and Google Scholar database were searched for all randomized controlled trials (RCTs) comparing LCBDE with EST in the treatment of choledocholithiasis.According to the inclusion and exclusion criteria,data were extracted by two reviewers independently,the quality of the included trials was evaluated.Meta-analyses were conducted on the residual rate and recurrence rate of choledocholithiasis in the two surgical protocols using the RevMan 5.3 software. Results: Twelve RCTs (1 414 cases) were included,there were 708 cases in LCBDE group and 706 cases in EST group.Meta analysis showed that there was no significant difference in residual rate between LCBDE group and EST group ( OR =0.48,95% CI :0.23-1.03, P =0.06).The recurrence rate of choledocholithiasis in LCBDE group was lower than that of EST group ( OR =0.32,95% CI :0.19-0.53, P< 0.0001). Conclusions: The residual stone rate of the two procedure is similar,but the treatment of choledocholithiasis in LCBDE is superior to that in EST after 6 months follow-up according to the recurrence rate of calculi.

关 键 词：胆总管结石 胆总管探查术 腹腔镜检查 括约肌切开术 内窥镜 手术后并发症 META分析 

分 类 号：R657.4[医药卫生—外科学]