急性重症胆囊炎急诊手术与胆囊穿刺术后择期手术疗效比较的Meta分析  

Meta-analysis of curative effect comparison between emergency operation and selective operation after gallbladder puncture for acute severe cholecystitis

作　　者：郭志唐 龙奎[1] 戈佳云[1] 张威 和平 GUO Zhitang;LONG Kui;GE Jiayun(Department of Hepatobiliary and Pancreatic Surgery,the Second Affiliated Hospital,Kunming Medical University,Kunming 650101,China;Department of General Surgery,Nujiang People's Hospital)

机构地区：[1]昆明医科大学第二附属医院肝胆胰外科,云南昆明650101 [2]怒江州人民医院普通外科

出　　处：《腹腔镜外科杂志》2024年第6期435-444,共10页Journal of Laparoscopic Surgery

基　　金：昆明医科大学第二附属医院院内临床研究项目(ynIIT2021013)。

摘　　要：目的:通过Meta分析比较急性重症胆囊炎急诊行腹腔镜胆囊切除术(LC)与超声引导下经皮经肝胆囊穿刺引流术(PTGBD)后择期行LC的临床疗效。方法:检索国内外多个数据库中关于急性重症胆囊炎急诊LC与PTGBD后择期行LC疗效比较的文献。检索时间为2015年1月1日至2023年8月31日。观察指标包括手术时间、术中出血量、术后住院时间、中转开腹率、术后腹腔引流时间、胃肠功能恢复时间、切口感染率、胆漏发生率、胆管损伤发生率及总并发症发生率,提取相关数据后应用RevMan 5.4软件进行Meta分析。结果:共纳入23项研究,累计样本量2097例,急诊LC组1008例、PTGBD联合LC组1089例。Meta分析结果显示,急诊LC组手术时间(WMD=-24.39,95%CI=-32.35~-16.44,P<0.00001)、术后腹腔引流时间(WMD=-1.96,95%CI=-2.56~-1.36,P<0.00001)、胃肠功能恢复时间(WMD=-1.03,95%CI=-1.37~-0.69,P<0.00001)、术后住院时间(WMD=-1.77,95%CI=-2.61~-0.93,P<0.0001)更长;术中出血量(WMD=-44.75,95%CI=-54.33~-35.17,P<0.00001)更多,中转开腹率(OR=0.38,95%CI=0.24~0.61,P<0.0001)、切口感染率(OR=0.37,95%CI=0.18~0.75,P=0.006)、胆漏发生率(OR=0.24,95%CI=0.13~0.44,P<0.00001)、胆管损伤发生率(OR=0.30,95%CI=0.10~0.90,P=0.03)、总并发症发生率(OR=0.26,95%CI=0.19~0.35,P<0.00001)高于PTGBD联合LC组。结论:急性重症胆囊炎经PTGBD后择期行LC的临床疗效优于急诊LC,是安全、可行的。Objective:To compare the clinical efficacy of emergency laparoscopic cholecystectomy(LC)and selective LC after ultrasound-guided percutaneous transhepatic gallbladder drainage(PTGBD)for acute severe cholecystitis by meta-analysis.Methods:A systematic search was conducted in multiple domestic and international databases to identify clinical studies comparing the therapeutic efficacy of emergency LC and selective LC after PTGBD.The search period was from Jan.1,2015 to Aug.31,2023.The observational indexes included operation time,intraoperative blood loss,postoperative hospital stay,rates of conversion to laparotomy,postoperative abdominal drainage time,gastrointestinal function recovery time,incidence of incision infection,bile leakage,bile duct injury and total complications.The relevant data were extracted and applied to meta-analysis by RevMan 5.4 software.Results:A total of 23 studies were included,with a cumulative sample size of 2097 cases in the literatures,1008 cases in the emergency LC group and 1089 cases in the selective LC after PTGBD group.The meta-analysis showed that the operation time(WMD=-24.39,95%CI=-32.35~-16.44,P<0.00001),postoperative abdominal drainage time(WMD=-1.96,95%CI=-2.56~-1.36,P<0.00001),gastrointestinal function recovery time(WMD=-1.03.,95%CI=-1.37~-0.69,P<0.00001)and postoperative hospital stay(WMD=-1.77,95%CI=-2.61~-0.93,P<0.0001)in emergency LC group were longer than those in selective LC after PTGBD group.The intraoperative blood loss(WMD=-44.75,95%CI=-54.33~-35.17,P<0.00001)in emergency LC group was more than that in selective LC after PTGBD group.The incidences of conversion to laparotomy(OR=0.38,95%CI=0.24~0.61,P<0.0001),incision infection(OR=0.37,95%CI=0.18~0.75,P=0.0006),bile leakage(OR=0.24,95%CI=0.13~0.44,P<0.00001),bile duct injury(OR=0.30,95%CI=0.10~0.90,P=0.03),and total complications(OR=0.26,95%CI=0.19~0.35,P<0.00001)in emergency LC group were higher than those in selective LC after PTGBD group.Conclusions:The clinical efficacy of selective LC after PTGBD for acute se-v

关 键 词：急性重症胆囊炎 胆囊切除术 腹腔镜 经皮经肝胆囊穿刺引流术 META分析 

分 类 号：R657.4[医药卫生—外科学]