保胆取石术后结石复发危险因素的Meta分析

Meta-analysis of recurrence rate and its risk factor after cholecystolithotomy

目的探讨保胆取石术后结石复发的危险因素,为保胆取石的适应证提供理论依据。方法检索中国生物医学文献服务系统、维普、中国知网、万方等数据库,并辅以手工检阅相关论文及其参考文献,按照预先制定的纳入和排除标准筛选文献,之后进行质量评价和数据提取,最后采用Stata 12.0软件进行荟萃分析和发表偏倚检测。结果本项目共纳入6项研究1002例患者,术后结石复发324例,荟萃分析结果显示保胆取石术后总的复发率为30%,结石复发危险因素比值比(OR值)及95%可信区间(CI)分别为:胆囊壁厚度>3 mm 6.48(3.25,12.93)、胆囊功能异常25.16(10.15,62.34)、结石家族史4.50(3.21,6.30)、结石多发4.93(3.23,7.52)、老年患者2.77(1.90,4.04)、性别1.15(0.84,1.58)、糖尿病1.06(0.71,1.59)。结论胆囊壁厚度>3 mm、胆囊功能异常、结石家族史、多发结石、老年患者为保胆取石术后结石复发的危险因素,性别、糖尿病与结石的复发没有明显联系。

Objective To investigate the risk factors in recurrence of cholecystolithotomy, and provide the basis for the indi？cation of cholecystolithotomy. Methods Published studies were searched in the CBM, CNKI, VIP, WanFang databases, and other relevant journals were also hand searched to identify all the relevant case. Eligible studies were selected according to the predefined in？clusion and exclusion criteria. Then the quality evaluation and data extraction were conducted. Meta？analysis publication bias exami？nation were done using software Stata 12.0. Results A total of 6 studies were included at last, including 1002 patients and 324 recur？rent cases. The results of the meta？analysis showed that the recurrence incidence after cholecystolithotomy was 30%. It was found that gallbladder wall thickness〉3 mm, gallbladder dysfunction, family history, multiple stone, advanced age, gender and diabetes had the pooled OR（95%CI） values as 6.48（3.25,12.93）, 25.16（10.15,62.34）, 4.50（3.21,6.3）, 4.93（3.23,7.52）, 2.77（1.90,4.04）, 1？15（0.84,1.58）, 1.06（0.71,1.59）. Conclusion Gallbladder wall thickness 〉3 mm, gallbladder dysfunction, family history, mul？tiple stone and advanced age are positively related to recurrence after cholecystolithotomy. Gender and diabetes are not the risk factor.