腹腔镜与开腹手术治疗慢性萎缩性胆囊炎疗效及安全性的Meta分析

Effects and Safety of Laparoscopic Cholecystectomy and Open Cholecystectomy for Chronic Atrophic Cholecystitis:A Meta-Analysis of RCTs

目的系统评价腹腔镜胆囊切除术(laporoscopic cholecystectomy,LC)与开腹胆囊切除术(open cholecystectomy,OC)治疗慢性萎缩性胆囊炎的疗效及安全性,为临床实践与研究提供参考。方法计算机检索PubMed、Web of science、Cochrane图书馆、CNKI、VIP、CBM和万方数据库,同时辅以其他检索。收集所有比较LC与OC治疗慢性萎缩性胆囊炎的随机对照试验(randomized controlled trial,RCT),选择适合本研究特点的质量评价标准对纳入文献进行质量评价,使用RevMan 5.2软件进行Meta分析。结果共纳入7篇涉及RCT的文献(758例患者)。①疗效评价:LC组的手术时间(MD=-27.70,95%CI:-44.25^-11.16,P=0.001)、术中出血量(MD=-113.25,95%CI:-141.68^-84.81,P<0.000 01)、胃肠功能恢复时间(MD=-28.49,95%CI:-29.80^-27.18,P<0.000 01)和住院时间(MD=-3.83,95%CI:-6.01^-1.65,P=0.000 6)短于或低于OC组,其中术中出血量和胃肠功能恢复时间的差异较明显。②安全性评价:2组患者术后在发生与胆囊切除术相关的并发症如胆瘘、肠粘连等方面(MD=0.24,95%CI:0.12~0.47,P<0.000 1)与止痛药使用率方面(MD=0.12,95%CI:0.06~0.23,P<0.000 01)比较,其差异均有统计学意义,LC组患者术后并发症发生率及止痛药使用率较OC组低。结论对慢性萎缩性胆囊炎行腹腔镜手术在疗效和安全性方面均优于开腹手术,但目前关于LC的临床随机对照试验较少且质量较差,其长期安全性评价尚需大样本高质量的RCT进一步验证。

Objective To systematically evaluation the efficacy and safety of laparoscopic cholecystectomy （LC）and open cholecystectomy （OC） for chronic atrophic cholecystitis. Methods Standard electronic database such as PubMed， Web of science， Cochrane library， CNKI， VIP， CBM， and Wanfang database were searched to retrieve relevant randomized controlled trials （RCTs） that comparing LC with OC， which were analyzed systematically using RevMan5.2. Results Seven RCTs including 758 patients were brought into this Meta analysis. There were significant differences between two groups regarding operative time （MD=-27.70， 95% CI：-44.25- -11.16， P=0.001）， amount of blood loss during operation （MD=-113.25， 95% CI：-141.68- -84.81， P＜0.000 01）， the recovery time of gastrointestinal function （MD=-28.49， 95% CI：-29.80- -27.18， P＜0.000 01）， and length of hospital stay （MD=-3.83， 95%CI：-6.01- -1.65， P=0.000 6） ， There were statistically significant difference in utilization rate of anodynes after operation （MD=0.12， 95% CI：0.06-0.23， P＜0.000 1） and terrible postoperative complications （MD=0.24， 95% CI：0.12-0.47， P＜0.000 01） between LC and OC. Conclusions In both efficacy and safety， LC for chronic atrophic cholecystitis are significantly superior than the traditional OC. But now the clinical randomized controlled trials about LC is less and the quality is poor， so that its long-term safety evaluation still needs large sample quality RCTs to be further verified.