经皮肝穿刺胆囊引流联合腹腔镜胆囊切除术与急诊腹腔镜胆囊切除术对中度急性胆囊炎疗效的Meta分析  

Therapeutic effects of percutaneous transhepatic gallbladder drainage+laparoscopic cholecystectomy versus emergency laparoscopic cholecystectomy on moderate acute cholecystitis:a Metaanalysis

作　　者：罗程 宋玖珊 梁琨[1] 余化霖[1] LUO Cheng;SONG Jiu-shan;LIANG Kun;YU Hua-lin(Department of Minimally Invasive Neurosurgery,the First Affiliated Hospital of Kunming Medical University,Kunming 650000,China)

机构地区：[1]昆明医科大学第一附属医院微创神经外科,云南昆明650000

出　　处：《肝胆胰外科杂志》2020年第6期364-370,共7页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的系统评价经皮肝穿刺胆囊引流联合腹腔镜胆囊切除术与急诊腹腔镜胆囊切除术的治疗方案选择对中度急性胆囊炎的治疗效果及不良反应。方法检索PubMed、EMBASE、Web of Science、Cochrane Library、中国期刊全文数据库(CNKI)、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)、万方数据库中有关经皮肝穿刺胆囊引流术联合腹腔镜胆囊切除术与急诊腹腔镜胆囊切除术对中度急性胆囊炎治疗的随机对照试验研究,检索时限为建库之日起至2018年5月。所有检索出并纳入研究的文献均由2名研究者进行独立的文献质量评价和数据提取。文献数据统一采用RevMan 5.3软件进行分析,对无法进行Meta分析的文献指标进行描述性分析。结果总共纳入11篇文献,包括1283例中度急性胆囊炎患者。Meta分析结果显示:在发生中度急性胆囊炎时经皮肝穿刺胆囊引流术联合腹腔镜胆囊切除术与急诊腹腔镜胆囊切除术相比可降低中转开腹率(RR 0.45,95%CI 0.23~0.85,P=0.01),减少术中出血量(SMD-41.50,95%CI-51.18^-31.82,P<0.001)和术后并发症发生率(RR 0.50,95%CI 0.31~0.81,P<0.001),但两种治疗方式在手术时间上的差异并无统计学意义(SMD 1.10,95%CI-4.27~6.47,P=0.69)。此外,经皮肝穿刺胆囊引流术联合腹腔镜胆囊切除术比急诊腹腔镜胆囊切除术能够更好地缩短患者术后住院时间(SMD-1.21,95%CI-2.17^-0.25,P=0.01)。结论在治疗中度急性胆囊炎时,经皮肝穿刺胆囊引流术联合腹腔镜胆囊切除术比急诊腹腔镜胆囊切除术具有更好的效果。Objective To systematic evaluate the efficacy and adverse reaction of percutaneous transhepatic gallbladder drainage+laparoscopic cholecystectomy(PTGBD+LC)versus emergency laparoscopic cholecystectomy(ELC)in treatment of moderate acute cholecystitis(MAC).Methods The randomized trials on PTGBD+LC and ELC for treatment of MAC were searched from databases of PubMed,EMBASE,Web of Science,Cochrane Library,CNKI,VIP,CBM and Wanfang Database.The search period was from the inception of the database to May 2018.All the literatures retrieved and included in the study were independently evaluated and extracted by two researchers.Literature results were dealt by RevMan 5.3.For the results that could not be procressed by Meta-analysis,descriptive analysis were employed.Results A total of 11 literatures were finally selected that contained 1283 MAC patients.Meta-analysis showed that,compared with ELC,PTGBD+LC could decrease the rate of conversion to open cholecystectomy(OC)(RR 0.45,95%CI 0.23~0.85,P=0.01),intraoperative blood loss(SMD-41.50,95%CI-51.18^-31.82,P<0.001)and postoperative complications incidence rate(RR 0.50,95%CI 0.31~0.81,P<0.001).However,the difference of operation time(SMD 1.10,95%CI-4.27~6.47,P=0.69)between PTGBD+LC group and ELC group had no statistical significance.Additionally,the hospitalization time(SMD-1.21,95%CI-2.17^-0.25,P=0.01)in PTGBD+LC group were shorter than that in ELC group.Conclusion This Meta-analysis shows that PTGBD+LC has better advantages than ELC in treatment of MAC.

关 键 词：经皮肝穿刺胆囊引流术 腹腔镜胆囊切除术 中度急性胆囊炎 META分析 

分 类 号：R657.41[医药卫生—外科学]