LC+LCBDE治疗胆囊结石合并胆总管结石疗效的Meta分析
| 作者: |
1曹继华,
1周大琼,
1李媛媛,
1张阳德
1 中南大学湘雅医院肝胆肠外科研究中心，长沙 410008 |
| 通讯: |
张阳德
Email: zyd99@189.cn |
| DOI: | 10.3978/j.issn.2095-6959.2014.02.008 |
摘要
目的：系统评价腹腔镜胆囊切除联合腹腔镜胆总管探查术(laparoscopic cholecystectomy plus common bile duct exploration，LC+LCBDE)和LC联合内镜下十二指肠乳头括约肌切开术(endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy，ERCP/S)治疗胆囊结石合并胆总管结石的临床疗效，为临床治疗提供最佳选择。方法：通过计算机检索中国知网(CNKI)、重庆维普(VIP)、PubMed及Embase数据库(从建库到2013年)，搜索所有LC+LCBDE和LC+ERCP/S治疗胆囊结石合并胆总管结石的随机对照试验。按照纳入和排除标准选择文献，提取资料，并在评价纳入研究的方法学质量后，采用RevMan5.1软件进行Meta分析。结果：11篇随机对照文献纳入研究，全为英文文献，共1 565例患者，其中LC+LCBDE组801例，LC+ERCP/S组764例。Meta分析结果显示两组结石清除率、中转手术率、残余结石率、并发症发生率、病死率以及住院时间比较，差异无统计学意义(P>0.05)；LC+LCBDE组在治疗胆囊结石合并胆总管结石所需的手术时间短于LC+ERCP/S组(P=0.0008)；LC+LCBDE组的住院费用低于LC+ERCP/S组。结论：LC+LCBDE治疗胆囊结石合并胆总管结石不仅安全、有效，而且比LC+ERCP/S更加经济实惠。
关键词：
胆囊结石；胆总管结石；腹腔镜胆总管探查；内镜下括约肌切开；Meta分析
Effect of LC+LCBDE on gallstones combined with common bile duct stones: A Meta-analysis
CorrespondingAuthor: ZHANG Yangde Email: zyd99@189.cn
DOI: 10.3978/j.issn.2095-6959.2014.02.008
Abstract
Objective: To evaluate the clinical effect of laparoscopic cholecystectomy plus common bile duct exploration (LC + LCBDE) and LC + endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy (ERCP/S) on gallstones combined with common bile duct stones, and to provide the optimal choice for clinical treatment. Methods: The databases including CNKI, VIP, PubMed, and Embase (from the date of establishment to 2013) were searched, and the related references were traced. All randomized controlled trials on comparing LC + ERCP/S with LC + LCBDE on cholecystohthiasis and chole docholithiasis were collected. The literature was screened according to inclusive criteria, the data were extracted and the quality of included studies was assessed. The Meta-analysis was conducted using RevMan 5.1 software. Results: A total of 11 randomized controlled trials with 1 567 patients were included. The Meta-analysis showed that there were no statistically significant difference between the LC + LCBDE and LC + ERCP/S groups in stone clearance from the common bile duct [OR=1.24, 95%CI (0.69, 2.24), P=0.47], residual stone rate[OR=1.01, 95%CI(0.65, 1.57), P=0.96], conversion to other procedures[OR=0.81, 95%CI (0.41, 1.57), P=0.53], length of hospital stay [MD=-0.66, 95%CI (-2.85, 1.52), P=0.55], and mortality[OR=0.93, 95%CI (0.46, 1.87), P=0.83]. There was significant difference in the total operative time [MD=-13.57, 95%CI(-21.53, -5.60), P=0.0008] between the LC + LCBDE and LC + ERCP/S groups. In total hospital charges, the LC + LCBDE group was less than that of the ERCP/S + LC group. Conclusion: LC + LCBDE for cholecystohthiasis combined with choledocholithiasis is not only safe and effective, but also more economic benefit compared to LC + ERCP/S.