腹腔镜联合胆道镜保胆取石术后结石复发危险因素的Meta分析  

Risk Factors of Postoperative Recurrence of Gallstones in Patients with Laparoscopic Choledochoscopy Assisted Removal of Cholecyscithiasis: A Meta-analysis

作　　者：林圣哲 李戈 陈江枝[1] 蔡欣然[1] 陈燕凌[1] LIN Shengzhe;LI Ge;CHEN Jiangzhi;CAI Xinran;CHEN Yanling(Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院肝胆外科,福建省肝胆外科研究所,福州350001

出　　处：《福建医科大学学报》2020年第5期300-307,共8页Journal of Fujian Medical University

摘　　要：目的探究腹腔镜联合胆道镜保胆取石术(LRCL)术后胆囊结石复发的危险因素。方法收集PubMed数据库、Cochrane Library图书馆数据库、Embase数据库、中国生物医学文献库、中国知网、维普数据库、万方数据库中已发表的、关于LRCL术后结石复发患者的回顾性研究,对所获得的文献根据纳入标准及排除标准进行筛选,对符合标准的研究进行质量评价,阅读文献并提取相关数据,对行LRCL患者的性别、年龄、胆石症家族史、胆囊多发结石情况、胆囊功能是否异常、胆囊壁厚度、急性胆囊炎发作史、是否服用熊去氧胆酸、有无高脂血症、高血压病、糖尿病等,以及是否肥胖、油腻饮食、运动等因素进行Meta分析。结果检索得到符合纳入标准的回顾性分析研究文献共12篇,总共纳入7214名患者,其中术后结石复发942例。Meta分析结果显示,保胆取石术后结石复发各危险因素的比值比(OR值)及95%可信区间(95%CI)分别为:胆囊多发结石(1.11,0.31~1.92,P<0.01)、胆石症家族史(1.37,0.76~1.98,P<0.01)、肥胖(1.04,0.61~1.48,P<0.0001)、高脂血症(1.12,0.65~1.58,P<0.001)、油腻饮食(1.41,0.45~2.37,P<0.01)、服用熊去氧胆酸(-0.85,-1.46^-0.24,P<0.01)、少数民族(0.65,0.47~0.84,P<0.0001)、胆囊功能(2.87,1.78~3.95,P<0.0001)、急性胆囊炎发作史(1.41,0.86~1.96,P<0.0001)。其他指标如胆囊壁厚度、性别、年龄、糖尿病、运动、高血压病等均P>0.05。结论胆囊多发结石、胆石症家族史、肥胖、高脂血症、油腻饮食是LRCL术后结石复发的危险因素。胆囊功能异常、胆囊炎急性发作史、少数民族是结石复发的可能危险因素。胆囊壁≥3 mm、高血压病、糖尿病、运动、年龄、性别与保胆取石术后结石复发无明显关系。术后服用熊去氧胆酸可以减少结石复发。Objective To evaluate the risk factors for the recurrence of gallstones after laparoscopic choledochoscopy-assisted removal of cholecyscithiasis(LRCL)through Meta analysis.Methods Retrospective studies on recurrence of gallstones after LRCL from PubMed databases,Cochrane Library databases,Embase databases,China Biology Medicine(CBM)databases,China National Knowledge Infrastructure(CNKI)databases,Wiper Database and Wanfang Database were collected.The obtained documents were screened according to the inclusion criteria and exclusion criteria.Then the quality evaluation and data extraction were conducted.The risk factors of gallstones recurrence after LRCL included age,sex,preoperative multiple gallstones,family history of cholelithiasis,obesity,hyperlipemia,greasy diet,taking ursodeoxycholic acid,gallbladder function,history of acute cholecystitis,minority,gallbladder wall thickness,diabetes mellitus,exercise and hypertension were analyzed.Rev Man 5.0 software was used for a meta analysis.Results A total of 12 retrospective case control studies with 7214 cases were enrolled.The results of meta analysis revealed that the risk factors of recurrence of gallstones after laparoscopic choledochoscopy-assisted removal of cholecyscithiasis(LRCL)included preoperative multiple gallstones(OR=1.11,95%CI:0.31-1.92,P<0.01),family history of cholelithiasis(OR=1.37,95%CI=0.76-1.98,P<0.01),obesity(OR=1.04,95%CI:0.61-1.48,P<0.0001),hyperlipemia(OR=1.12,95%CI:0.65-1.58,P<0.001),greasy diet(OR=1.41,95%CI:0.45-2.37,P<0.01),ursodeoxycholic acid(OR=-0.85,95%CI:-1.46--0.24,P<0.01),gallbladder function(OR=2.87,95%CI:1.78-3.95,P<0.0001),history of acute cholecystitis(OR=1.41,95%CI:0.86-1.96,P<0.0001),minority(OR=0.65,95%CI:0.47-0.8,P<0.0001).Other factors like gallbladder wall thickness,age,sex,diabetes mellitus,exercise and hypertension did not show significant difference(P>0.05).Conclusions Multiple gallstones,family history of cholelithiasis,obesity,hyperlipidemia and greasy diet are risk factors for the recurrence of gallstones after LR

关 键 词：胆囊结石病 胆结石 腹腔镜 内镜检查 消化系统 复发 危险因素 META分析 

分 类 号：R364.25[医药卫生—病理学] R443.8[医药卫生—基础医学]