腹腔镜胆囊切除术发生胆管损伤危险因素的Meta分析  

Meta-analysis of Risk Factors for Bile Duct Injury in Laparoscopic Cholecystectomy

作　　者：王志 蒋宏伟 冯汝状 WANG Zhi;JIANG Hong-wei;FENG Ru-zhuang(The Second Department of Hepatobiliary Surgery,New District Hospital of Chuxiong People's Hospital,Chuxiong 650500,Yunnan,China)

机构地区：[1]楚雄州人民医院新区医院肝胆外二科,云南楚雄650500

出　　处：《医学信息》2023年第20期69-73,82,共6页Journal of Medical Information

摘　　要：目的探讨腹腔镜胆囊切除术发生胆管损伤的危险因素。方法计算机检索中国知网(CNKI)、万方数据知识服务平台、中国生物医学文献服务平台、维普资讯中文期刊服务平台、PubMed、Web of Science、Cochrane Library以及EMbase数据库在建库至2022年11月10日公开发表的腹腔镜胆囊切除术发生胆管损伤相关文献。由两位评价人员分别独立筛选文献、提取数据,并进行文献质量评价。采用RevMan 5.3软件进行Meta分析。结果最终入选6篇文献,均为回顾性病例对照研究,共19411例患者,腹腔镜胆囊切除术发生胆管损伤共151例患者,未发生胆管损伤共19260例患者,胆管损伤发生率为0.78%。Meta分析显示,胆囊(胆管)解剖异常[OR=69.24,95%CI(43.34,110.62),P<0.00001]、术者经验差[OR=9.16,95%CI(5.12,16.37),P<0.00001]为腹腔镜胆囊切除术发生胆管损伤的危险因素。结论胆管解剖异常、术者经验差为腹腔镜胆囊切除术发生胆管损伤危险因素。临床医生应注意相关危险因素,尽可能避免胆管损伤,提高患者术后生活质量。Objective To investigate the risk factors of bile duct injury in laparoscopic cholecystectomy.Methods China National Knowledge Infrastructure(CNKI),Wanfang Data Knowledge Service Platform,Chinese Biomedical Literature Service Platform,VIP Information Chinese Journal Service Platform,PubMed,Web of Science,Cochrane Library and EMbase Database were searched by computer to retrieve the literature related to bile duct injury in laparoscopic cholecystectomy published between the establishment of the database and November 10,2022.Two evaluators independently screened the literature,extracted the data,and evaluated the quality of the literature.Meta-analysis was performed using RevMan 5.3 software.Results Finally,6 literatures were included,all of which were retrospective case-control studies,with a total of 19411 patients,151 patients with laparoscopic cholecystectomy with bile duct injury,and 19260 patients without bile duct injury,with an incidence of 0.78%.Final Meta results showed that the anatomical abnormality of gallbladder(bile duct)[OR=69.24,95%CI(43.34,110.62),P<0.00001],the operator had poor experience[OR=9.16,95%CI(5.12,16.37),P<0.00001]were the risk factor for bile duct injury in laparoscopic cholecystectomy.Conclusion Abnormal bile duct anatomy and poor experience are risk factors for bile duct injury in laparoscopic cholecystectomy.Clinicians should pay attention to relevant risk factors,avoid bile duct injury as much as possible,and improve the quality of life of patients after surgery.

关 键 词：腹腔镜胆囊切除术 胆管损伤 危险因素 胆汁性腹膜炎 

分 类 号：R657.4[医药卫生—外科学]