经ERCP胆道支架植入术与胆道取石术对高危患者胆总管结石疗效比较的Meta分析  

Biliary stent placement through ERCP versus biliary lithotomy through ERCP in the treatment of common bile duct stones in high-risk patients:ameta-analysis

作　　者：李昕锴 杨小李 方程 苏松 李波 LI Xinkai;YANG Xiaoli;FANG Cheng;SU Song;LI Bo(Department of Hepatobiliary Surgery,The Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China;Sichuan Academician(Expert)Workstation,Luzhou,Sichuan 646000,China)

机构地区：[1]西南医科大学附属医院肝胆外科,四川泸州646000 [2]四川省院士(专家)工作站,四川泸州646000

出　　处：《重庆医学》2023年第12期1870-1875,1881,共7页Chongqing medicine

基　　金：四川省科技厅重点研发项目(2021YFS0105)。

摘　　要：目的比较经内镜逆行胰胆管造影(ERCP)胆道支架植入术与经ERCP胆道取石术治疗高危患者胆总管结石的有效性与安全性。方法检索Pubmed、Web of Science、Cochrane Library、知网、中国生物医学文献、维普、万方数据库1990年1月至2022年1月公开发表的文献,比较经ERCP胆道支架植入术与经ERCP胆道取石术在高危患者胆总管结石中的疗效比较。并使用RevMan5.4软件进行数据分析。结果最终纳入6篇文献,共619例患者。Meta分析结果显示:与取石组相比,支架组术后近期总体并发症减少(OR=0.44,95%CI:0.27~0.73,P<0.05),术后远期胆管炎增多(OR=6.81,95%CI:1.70~27.30,P<0.05);两组住院时间,术后消化道出血,术后腹膜后穿孔,手术时间,术后近期胆管炎,再次行ERCP治疗率,术后胰腺炎及术后死亡率比较,差异无统计学意义(P>0.05)。结论经ERCP胆道支架置入术较经ERCP胆道取石术治疗高危患者胆总管结石更加安全、有效。Objective To compare the efficacy and safety of biliary stent placement through endoscopic retrograde cholangiopancreatography(ERCP)and biliary lithotomy through ERCP in the treatment of common bile duct stones in high-risk patients.Methods Pubmed,Web of Science,Cochrane Library,CNKI,CBM,VIP and Wanfang database were systematically searched for the articles on the comparison of biliary stent placement through ERCP and biliary lithotomy through ERCP in the treatment of common bile duct stones in high-risk patients published from January 1990 to February 2022.After the quality evaluation of the included literature,RevMan5.4 software was used for statistical analysis.Results Finally,a total of six studies with 619 patients were included.The results of meta-analysis showed that compared with the lithotomy group,the overall postoperative complications of the stent group was significantly reduced(OR=0.44,95%CI:0.27-0.73,P<0.05),and postoperative long-term recurrence of cholangitis were significantly increase(OR=6.81,95%CI:1.70-27.30,P<0.05);There were no significant differences in hospital stay,postoperative gastrointestinal bleeding,postoperative retroperitoneal perforation,operation time,recent postoperative recurrence of cholangitis,re-ERCP treatment rate,postoperative pancreatitis,postoperative mortality between the two groups.Conclusion Biliary stent placement through ERCP is safer and more effective than biliary lithotomy through ERCP in the treatment of common bile duct stones in high-risk patients.

关 键 词：内镜逆行胰胆管造影 支架植入术 胆道取石术 胆总管结石 META分析 

分 类 号：R657.42[医药卫生—外科学]