硬质胆道镜经皮经肝胆道造瘘取石术治疗肝内胆管结石临床疗效的荟萃分析  

Clinical efficacy of rigid choledochoscopic percutaneous transhepatic biliary fistulation lithotripsy for hepatolithiasis:a meta-analysis

作　　者：黄鑫 黄才如 林科灿 罗顺峰 黄起桢 赖子森 曾永毅 Huang Xin;Huang Cairu;Lin Kecan;Luo Shunfeng;Huang Qizhen;Lai Zisen;Zeng Yongyi(Department of Hepatobiliary Surgery,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350025,China)

机构地区：[1]福建医科大学孟超肝胆医院肝胆外科,福州350025

出　　处：《中华肝胆外科杂志》2023年第10期760-767,共8页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金面上项目(62275050);福建省卫健委中青年科研重大项目(2021ZQNZD013)。

摘　　要：目的分析预测硬质胆道镜经皮经肝胆道造瘘(PTBF)取石术治疗肝内胆管结石的临床疗效。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据库1990年1月1日至2022年3月1日使用硬质胆道镜PTBF取石术治疗肝内胆管结石的研究。采用马尔科夫链蒙特卡洛方法模拟后验分布进行贝叶斯分析,分析结石取尽率、结石复发率、术后总并发症发生率、术后胆道相关并发症发生率等指标。结果最终纳入15篇文献1 296例患者,其中文献中明确显示为复杂性肝内胆管结石患者1 008例[分为经皮经肝I期胆道造瘘(PTOBF)取石组(n=568)与经皮经肝II期胆道造瘘(PTTBF)取石组(n=440)]。PTOBF取石术治疗肝内胆管结石的结石取尽率、复发率、术后总并发症率分别为84.19%(95%HPD:79.08%~88.93%)、15.79%(95%HPD:11.01%~21.07%)、10.85%(95%HPD:7.93%~14.21%)。对于复杂性肝内胆管结石:PTOBF取石术的结石取尽率、复发率、术后总并发症率分别为82.58%(95%HPD:75.46%~88.83%)、17.99%(95%HPD:11.51%~25.45%)、10.34%(95%HPD:6.42%~15.40%);PTTBF取石术的结石取尽率、复发率、术后总并发症率分别为73.56%(95%HPD:65.67%~80.30%)、29.48%(95%HPD:23.13%~36.01%)、11.42%(95%HPD:6.18%~17.67%)。与PTTBF取石组相比,PTOBF取石组取石效率更高(OR=1.74,95%CI:1.17~2.60)、结石复发率更低(OR=0.56,95%CI:0.37~0.84),但并没有增加总并发症发生率(OR=1.03,95%CI:0.66~1.62)与胆道感染发生率(OR=1.12,95%CI:0.61~2.04)。结论使用硬质胆道镜PTBF取石术治疗肝内胆管结石安全、有效。对于复杂性肝内胆管结石,PTOBF取石组的取石效率更高、结石复发率更低。Objective To analyze and predict the clinical efficacy of rigid choledochoscopic percutaneous transhepatic biliary fistulation(PTBF)lithotripsy for the treatment of hepatolithiasis.Methods Databases including PubMed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang were searched for literatures from January 1,1990 to March 1,2022 on rigid choledochoscopic PTBF lithotripsy for hepatolithiasis studies.The primary outcomes including the final clearance rate,recurrence rate and overall postoperative complication rate,were analyzed by the random effects model in meta analysis and Bayesian network.The Markov Chain Monte Carlo was used for evaluation and prediction.Results Fifteen articles were ultimately included,involving 1296 patients,of which 1008 patients were clearly shown to have complex intrahepatic bile duct stones in the literature[divided into two groups,the percutaneous transhepatic one-step biliary fistulation(PTOBF)stone removal group(n=568)and the percutaneous transhepatic two-step biliary fistulation(PTTBF)stone removal group(n=440)].The results of Bayesian single-arm meta-analysis showed that the final clearance rate,recurrence rate and overall postoperative complication rate of PTOBF for hepatolithiasis were 84.19%(95%HPD:79.08%-88.93%),15.79%(95%HPD:11.01%-21.07%)and 10.85%(95%HPD:7.93%-14.21%).For complex hepatolithiasis,the final clearance rate,recurrence rate and overall postoperative complication rate of PTOBF were 82.58%(95%HPD:75.46%-88.83%),17.99%(95%HPD:11.51%-25.45%),10.34%(95%HPD:6.42%-15.40%).For PTTBF,they were respectively 73.56%(95%HPD:65.67%-80.30%),29.48%(95%HPD:23.13%-36.01%),11.42%(95%HPD:6.18%-17.67%).In comparison to PTTBF,the patients treated with PTOBF has a higher clearance rate(OR=1.74,95%CI:1.17-2.60)and a lower recurrence rate(OR=0.56,95%CI:0.37-0.84)but the overall complication rate did not improve(OR=1.03,95%CI:0.66-1.62).Conclusions Rigid choledochoscopic PTBF lithotripsy for hepatolithiasis is safe,effective and feasible.For complex hepatolithiasis,PTOBF has a higher cl

关 键 词：胆石 硬质胆道镜 经皮经肝胆道造瘘取石术 荟萃分析 

分 类 号：R657.4[医药卫生—外科学]