老年急性胆囊炎经皮经肝胆囊穿刺引流术后最佳手术时机的Meta分析  

The optimal surgical timing after percutaneous transhepatic gallbladder drainage for acute cholecystitis in the elderly:a metaanalysis

作　　者：李小红 张孔玺 李越洲 商中华[1] LI Xiao-hong;ZHANG Kong-xi;LI Yue-zhou(Department of General Surgery,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院普通外科,山西太原030001

出　　处：《腹腔镜外科杂志》2023年第2期123-132,共10页Journal of Laparoscopic Surgery

摘　　要：目的:比较老年急性胆囊炎经皮经肝胆囊穿刺引流术(PTGBD)后不同手术时机行腹腔镜胆囊切除术(LC)的治疗效果,以确定最佳手术时机。方法:检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、中国期刊全文数据库、万方数据库等于2022年5月前发表的关于老年急性胆囊炎行PTGBD后不同时间行LC治疗效果的临床研究。按纳入与排除标准纳入文献,并提取相关数据与资料,采用RevMan 5.4软件进行Meta分析。结果:共纳入12篇文献、1784例患者,比较间隔2个月内与2个月后施术的相关指标,结果显示,两组术后住院时间差异无统计学意义,间隔2个月后组胆囊壁厚度、手术时间、术中出血量、中转开腹率、术后引流管留置时间、术后总并发症发生率、总住院时间均优于间隔2月内组。将2月后组分为2~4个月组、4个月后组,分别与2个月内组进行比较,除胆囊壁厚度差异无统计学意义外,间隔2~4个月组与4个月后组手术时间、术中出血量、中转开腹率、术后并发症总发生率优于2个月内组。结论:老年急性胆囊炎行PTGBD后间隔2个月行LC的治疗效果较好。Objective:To compare the therapeutic effects of laparoscopic cholecystectomy(LC)at different operating opportunity after percutaneous transhepatic gallbladder drainage(PTGBD)in elderly patients with acute cholecystitis to determine the appropriate operation opportunity.Methods:PubMed,Embase,Cochrane Library,Web of Science,China biomedical literature database,China journal full-text database,Wanfang database and other databases were searched for clinical studies published before May 2022 on the therapeutic effect of LC at different surgical timing after PTGBD in elderly patients with acute cholecystitis.The literatures were included according to the inclusion and exclusion criteria,and relevant data and information were extracted,and RevMan 5.4 software was used for meta-analysis.Results:A total of 12 articles and 1784 patients were included.Comparing the relevant indicators within 2 months and 2 months later,the results showed that,except the difference of postoperative hospital stay was not statistically significant,the thickness of the gallbladder wall,operation time,intraoperative blood loss,rate of conversion to laparotomy,postoperative drainage tube indwelling time,total postoperative complication rate,total hospital stay in the group after interval of 2 months were better than those in the group within 2 months of interval.The group after 2 months was divided into group 2-4 months and group after 4 months,respectively,and subgroup analysis was performed for comparison with those within 2 months.Except for the thickness of the gallbladder wall,the operation time,intraoperative blood loss,conversion to laparotomy rate,and total incidence of postoperative complications in the group 2-4 months and the group after 4 months were significantly better than those in the group within 2 months.Conclusions:The treatment effect of LC 2 months after PTGBD in elderly patients with acute cholecystitis is better.

关 键 词：胆囊炎 急性 经皮经肝胆囊穿刺引流术 胆囊切除术 腹腔镜 老年人 手术时机 META分析 

分 类 号：R657.4[医药卫生—外科学]