急性胆囊炎早期与延迟腹腔镜手术对比的Meta分析  

Early laparoscopic cholecystectomy compared with delayed laparoscopic cholecystectomy for acute cholecystitis:a systematic review and meta-analysis

作　　者：巫泓生 马克强 嵇腾飞 黄健斌 邱旭彬 曹天生[1] WU Hong-sheng;MA Ke-qiang;JI Teng-fei(Department of Hepatobiliary Pancreatic Surgery,Affiliated Huadu Hospital,Southern Medical University,People’s Hospital of Huadu District,Guangzhou 510800,China)

机构地区：[1]广州市花都区人民医院肝胆胰外科,广东广州510800

出　　处：《腹腔镜外科杂志》2022年第7期527-534,共8页Journal of Laparoscopic Surgery

摘　　要：目的:评价急性胆囊炎行早期腹腔镜胆囊切除术(ELC)与延迟腹腔镜胆囊切除术(DLC)的手术并发症、中转开腹率及卫生经济学指标。方法:通过计算机检索2000年1月至2020年12月PubMed、Springer、Cochrane、万方、中国知网数据库有关急性胆囊炎行ELC与DLC对比的中英文文献,回顾性研究相关文献采用纽卡斯尔-渥太华量表进行文献质量评价,随机对照研究采用Cochrane系统评价工具进行评价,应用Review Manager 5.2软件进行Meta分析。结果:经过文献筛选及资料提取,共12篇文献、4773例患者纳入研究,10篇为随机对照研究,2篇为回顾性研究。Meta分析结果显示,DLC组总住院时间长于ELC组(WMD=-4.03,95%CI:-5.25~-2.82,P<0.00001),DLC组手术时间长于ELC组(WMD=3.30,95%CI:0.99~5.60,P=0.005),两组术中与术后并发症、中转开腹率及术后住院时间差异无统计学意义。结论:ELC与DLC治疗急性胆囊炎在手术并发症、中转开腹率方面无明显差别,但ELC可缩短手术时间与住院时间,具有一定的卫生经济效益。Objective:To evaluate the operative complications,rate of conversion to laparotomy and health economic indexes of early laparoscopic cholecystectomy(ELC)and delayed laparoscopic cholecystectomy(DLC)in acute cholecystitis.Methods:The English and Chinese literatures on the comparison of ELC and DLC from Jan.2000 to Dec.2020 were searched in PubMed,Springer,Co chrane,Wanfang and CNKI databases.The literature quality of the retrospective research was evaluated according to the Newcastle-Ottawa scale,the literature quality of randomized controlled trial was evaluated according to the Cochrane systematic evaluation method,and meta-analysis was carried out by Review Manager 5.2 software.Results:After literature screening and data extraction,4773 pa tients from 12 studies were included in the study,of which 10 were randomized controlled trials and 2 were retrospective studies.The meta-analysis results showed that the total hospital stay of the DLC group was significantly longer than that of the ELC group(WMD=-4.03,95%CI:-5.25 to-2.82,P<0.00001),the operation time in the DLC group was significantly longer than that in the ELC group(WMD=3.30,95%CI:0.99 to 5.60,P=0.005).There was no significant difference in intraoperative and postoperative complications,conversion rate and postoperative hospital stay.Conclusions:Clinically,there is no significant difference between ELC and DLC in surgical complications and conversion to laparotomy in patients with acute cholecystitis,ELC can significantly shorten the operation time and hospital stay,so it has certain health and economic benefits.

关 键 词：胆囊炎 急性 胆囊切除术 腹腔镜 早期手术 延迟手术 META分析 

分 类 号：R657.4[医药卫生—外科学]