腹腔镜胆囊切除术联合术中内镜下括约肌切开术治疗胆囊结石合并胆总管结石的Meta分析

Meta analysis of laparoscopic cholecystectomy combined with intra-operative endoscopic sphincterotomy for cholecysto-choledocholithiasis

摘要:

目的：系统评价腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）联合术中内镜下括约肌切开术（intra-operative endoscopic sphincterotomy，IOES）与LC联合术前内镜下括约肌切开术（preoperative endoscopic sphincterotomy，POES）治疗胆囊结石合并胆总管结石的临床疗效。方法：检索Cochrane Library、PubMed、EMbase、中国生物医学数据库等，查找1990年5月至2012年5月发表的关于LC+IOES和LC+POES治疗胆囊结石合并胆总管结石的随机对照试验，采用 RevMan5.0软件进行 Meta 分析。结果：共纳入5个随机对照试验，合计631例患者。Meta分析结果表明：与LC+POES相比，LC+IOES能够降低内镜逆行胰胆管造影/括约肌切开术（endoscopic retrograde cholangio pancreatography/sphincterotomy，ERCP/S）术后并发症[RR=0.46，95%CI（0.24，0.88），P=0.02]，尤其是胰腺炎的发生率[RR=0.21，95%CI（0.06，0.71），P=0.01]，缩短住院天数[WMD=-2.13，95%CI（-2.70，-1.56），P<0.000 01]和减少住院费用[WMD=-352.61，95%CI（-637.18，-68.03），P=0.02]；两组在手术成功率上无统计学意义[RR=1.00，95%CI（0.94，1.07），P=0.99]。结论：LC+IOES治疗胆囊结石合并胆总管结石是安全有效的，值得在临床上推广应用。

Abstract:

Objective：To systematically evaluate the effectiveness of laparoscopic cholecystectomy（LC） combined with either intra-op－erative or preoperative endoscopic sphincterotomy（IOES or POES） in the treatment of cholecysto-choledocholithiasis. Methods：Cochrane Library，PubMed，EMbase and CBM data bases were searched to identify randomized controlled trials（RCTs） published between May 1990 and May 2012 in which the effectiveness of LC+IOES was compared with that of LC+POES. Meta analysis was performed using the software RevMan5.0. Results：Five RCTs with 631 patients were included. Meta analysis revealed that compared with those of LC+POES，LC+IOES significantly reduced the postoperative complication rate of endoscopic retrograde cholangio pan－creatography/sphincterotomy（ERCP/S）（RR=0.46，95%CI（0.24，0.88），P=0.02），especially that of acute pancreatitis（RR=0.21，95%CI（0.06，0.71），P=0.01）；shorten hospital duration（WMD=-2.13，95%CI（-2.70，-1.56），P<0.000 01） and reduced hospitalization cost（WMD=-352.61，95%CI（-637.18，-68.03），P=0.02）. There was no difference between the two groups regarding the successful rate of surgery（RR=1.00，95%CI（0.94，1.07），P=0.99）. Conclusion：LC+IOES is effective and safe in the treatment of cholecysto-choledo－cholithiasis and worth clinical promotion