腹腔镜经胆囊管汇合部微切开胆总管探查术与腹腔镜胆总管探查术治疗胆总管结石疗效与安全性的荟萃分析
A meta-analysis of the efficacy and safety of laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration versus laparoscopic common bile duct exploration in the treatment of choledochal stones
赵云 1吴鹏 1别玉坤 1冯以斌 1韩登科2
作者信息
- 1. 安康市中心医院肝胆外科,安康 725000
- 2. 安康市中心医院消化内科,安康 725000
- 折叠
摘要
目的 系统评价腹腔镜经胆囊管汇合部微切开胆总管探查术(LTM-CBDE)与腹腔镜胆总管探查术(LCBDE)治疗胆总管结石的疗效及安全性.方法 检索Pubmed、Library、Embase、Cochrane、中国知网、维普、中国生物医学文献数据库、万方等数据库,收集2013年12月至2023年12月有关LTM-CBDE治疗胆总管结石的相关文献.主要观察指标为手术时间、术中出血量、引流管带管时间、术后胃肠道功能恢复时间、住院时间和术后并发症发生率.采用Review Manager 5.4软件进行荟萃分析.结果 共纳入15项研究,其中英文文献1篇,中文文献14篇;5篇为随机对照临床试验,10篇为病例对照研究.共1493例患者,其中男性690例,女性803例,年龄(53.7±9.2)岁.1 493例患者中,732例患者行LTM-CBDE为微切开组,761例患者行LCBDE为对照组.荟萃分析显示,与对照组比较,微切开组患者引流管带管时间短(MD=-3.34,95％CI:-4.69～-1.99,P＜0.001)、术后胃肠道功能恢复时间快(MD=-0.63,95％CI:-1.00～-0.25,P=0.001)、住院时间短(MD=-2.18,95％CI:-2.79～-1.57,P＜0.001),胆漏(OR=0.36,95％CI:0.22～0.59,P＜0.001)及总体并发症(OR=0.28,95％CI:0.18～0.42,P＜0.001)发生率均降低.结论 相较于LCBDE,LTM-CBDE治疗胆总管结石更加安全有效,值得临床推广.
Abstract
Objective To systematically evaluate the efficacy and safety of laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration(LTM-CBDE)versus laparoscopic common bile duct exploration(LCBDE)for the treatment of choledocholithiasis.Methods PubMed,Library,Embase,Cochrane,CNKI,VIP,CBMdisc,Wanfang and other databases were searched to collect relevant literature about LTM-CBDE treatment of choledocholithiasis from December 2013 to December 2023.The main observational indexes were operation time,intraoperative bleeding,drainage tube banding time,postoperative gastrointestinal function recovery time,hospitalization time and postoperative complication rate.Meta-analysis was performed using Review Manager 5.4 software.Results A total of 15 studies were collected,including one in English and 14 in Chinese.Five were randomized con-trolled clinical trials and 10 were case-control studies.A total of 1 493 patients,including 690 males and 803 females,aged(53.7±9.2)years old.Among them,732 patients underwent LTM-CBDE as the micro-dissection group and 761 patients underwent LCBDE as the control group.Compared with the control group,the meta-analysis showed that patients in the microdissection group had a shorter drain banding time(MD=-3.34,95％CI:-4.69--1.99,P＜0.001),a faster recovery time of postoperative gastrointestinal function(MD=-0.63,95％CI:-1.00--0.25,P=0.001),a shorter hospital stay(MD=-2.18,and 95％CI:-2.79--1.57,P＜0.001),and a lower incidence of bile leak(OR=0.36,95％CI:0.22-0.59,P＜0.001)and overall complications(OR=0.28,95％CI:0.18-0.42,P＜0.001).Conclusion LTM-CBDE is safer and more effective than LCBDE in the treatment of choledocholithiasis and deserves clinical promotion.
关键词
胆石症/胆囊管汇合部/微切开/胆总管探查术/Meta分析Key words
Cholelithiasis/Confluence of choledochal ducts/Microtomy/Common bile duct exploration/Meta-analysis引用本文复制引用
出版年
2024
NETL
NSTL
万方数据