中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2013年
10期
752-757
,共6页
陈超波%仇毓东%顾盐炎%蔡浩
陳超波%仇毓東%顧鹽炎%蔡浩
진초파%구육동%고염염%채호
胆结石%胆囊切除术,腹腔镜%胰胆管造影术%内窥镜逆行%Meta分析
膽結石%膽囊切除術,腹腔鏡%胰膽管造影術%內窺鏡逆行%Meta分析
담결석%담낭절제술,복강경%이담관조영술%내규경역행%Meta분석
Cholelithiasis%Cholecystectomy,laparoscopic%Cholangiopancreatography%Endoscopic retrograde%Meta analysis
目的 对腹腔镜胆囊切除联合胆总管探查取石(LC+ LCBDE)与内镜逆行胰胆管造影/内镜下括约肌切开取石术(EST)联合腹腔镜胆囊切除术(ERCP/EST+ LC)治疗胆囊结石合并胆总管结石的有效性及安全性进行比较.方法 在Pubmed、EMBASE、中国知网数据库中检索1990至2013年3月发表的比较LC+LCBDE和ERCP/EST+LC疗效的随机对照研究,并应用Revman 5.1进行Meta分析.分析的主要内容为结石清除率、并发症发生率、手术时间和住院时间.结果 9项研究最终入选,包括1021例患者.Meta分析提示,LC+ LCBDE和ERCP/EST+ LC在结石清除率(OR 1.55,95％CI 0.95～2.52,P=0.08)、并发症发生率(OR 1.12,95％CI 0.75～1.67,P=0.58)、手术时间(WMD-54.44,95％CI-107.7～-1.17,P=0.05)及住院时间(WMD-0.22,95％CI-2.6～2.16,P=0.86)方面的差异无统计学意义.结石清除率Meta分析的P值随着纳入文献的增多,逐渐接近0.05.因为样本量较小,手术时间的Meta分析也未得出明显差异.结论 LC+LCBDE和ERCP/EST+LC具有相似的结石清除率和并发症发生率,并且在手术时间及住院时间方面两者也无明显差异.但随着研究样本量的增大,LC+ LCBDE在结石清除率和手术时间方面的优越性将会凸显.
目的 對腹腔鏡膽囊切除聯閤膽總管探查取石(LC+ LCBDE)與內鏡逆行胰膽管造影/內鏡下括約肌切開取石術(EST)聯閤腹腔鏡膽囊切除術(ERCP/EST+ LC)治療膽囊結石閤併膽總管結石的有效性及安全性進行比較.方法 在Pubmed、EMBASE、中國知網數據庫中檢索1990至2013年3月髮錶的比較LC+LCBDE和ERCP/EST+LC療效的隨機對照研究,併應用Revman 5.1進行Meta分析.分析的主要內容為結石清除率、併髮癥髮生率、手術時間和住院時間.結果 9項研究最終入選,包括1021例患者.Meta分析提示,LC+ LCBDE和ERCP/EST+ LC在結石清除率(OR 1.55,95％CI 0.95～2.52,P=0.08)、併髮癥髮生率(OR 1.12,95％CI 0.75～1.67,P=0.58)、手術時間(WMD-54.44,95％CI-107.7～-1.17,P=0.05)及住院時間(WMD-0.22,95％CI-2.6～2.16,P=0.86)方麵的差異無統計學意義.結石清除率Meta分析的P值隨著納入文獻的增多,逐漸接近0.05.因為樣本量較小,手術時間的Meta分析也未得齣明顯差異.結論 LC+LCBDE和ERCP/EST+LC具有相似的結石清除率和併髮癥髮生率,併且在手術時間及住院時間方麵兩者也無明顯差異.但隨著研究樣本量的增大,LC+ LCBDE在結石清除率和手術時間方麵的優越性將會凸顯.
목적 대복강경담낭절제연합담총관탐사취석(LC+ LCBDE)여내경역행이담관조영/내경하괄약기절개취석술(EST)연합복강경담낭절제술(ERCP/EST+ LC)치료담낭결석합병담총관결석적유효성급안전성진행비교.방법 재Pubmed、EMBASE、중국지망수거고중검색1990지2013년3월발표적비교LC+LCBDE화ERCP/EST+LC료효적수궤대조연구,병응용Revman 5.1진행Meta분석.분석적주요내용위결석청제솔、병발증발생솔、수술시간화주원시간.결과 9항연구최종입선,포괄1021례환자.Meta분석제시,LC+ LCBDE화ERCP/EST+ LC재결석청제솔(OR 1.55,95％CI 0.95～2.52,P=0.08)、병발증발생솔(OR 1.12,95％CI 0.75～1.67,P=0.58)、수술시간(WMD-54.44,95％CI-107.7～-1.17,P=0.05)급주원시간(WMD-0.22,95％CI-2.6～2.16,P=0.86)방면적차이무통계학의의.결석청제솔Meta분석적P치수착납입문헌적증다,축점접근0.05.인위양본량교소,수술시간적Meta분석야미득출명현차이.결론 LC+LCBDE화ERCP/EST+LC구유상사적결석청제솔화병발증발생솔,병차재수술시간급주원시간방면량자야무명현차이.단수착연구양본량적증대,LC+ LCBDE재결석청제솔화수술시간방면적우월성장회철현.
Objective To compare the safety and efficiency of laparoscopic cholecystectomy (LC) + laparoscopic common bile duct exploration (LCBDE) with endoscopic retrograde cholangiopancreatography (ERCP) /endoscopic sphincterotomy (EST) +LC for patients with concomitant gallstones and common bile duct stones.Methods The Pubmed,EMBASE and CNKI were searched for randomized controlled trials published from 1990 to March,2012.Revman 5.1 was used to perform the meta-analysis.The main outcomes were stone clearance rate,treatment morbidity,operative time and length of hospital stay.Results 9 studies with 1021 patients were included into the final analysis.Meta-analysis demonstrated that LC+LCBDE was similar to ERCP/EST+LC in the stone clearance rate (OR 1.55,95％CI 0.95～2.52,P=0.08),treatment morbidity (OR 1.12,95％CI 0.75～1.67,P=0.58),operative time (WMD-54.44,95％CI-107.7～-1.17,P=0.05) and length of hospital stay (WMD-0.22,95％CI-2.6～2.16,P=0.86).The P value of the stone clearance rate was approaching 0.05 with increased number of studies in the analysis.There was no significant difference in the operative time,probably because of small sample size.Conclusions LC-LCBDE was equivalent to ERCP/EST+ LC in stone clearance rate,treatment morbidity,operative time and length of hospital stay.There is a possibility that LC+LCBDE can be superior to ERCP/EST+LC in the stone clearance rate and the operative time with increase in sample size.
