经内镜逆行性胰胆管造影术取石后胆道结石复发的危险因素的Meta分析

Risk factors related to bile duct stone recurrence after endoscopic retrograde cholangio-pancreatography:a Meta analysis

[目的]采用Meta分析的方法系统评价经内镜逆行性胰胆管造影术(ERCP)取石后结石复发的相关危险因素。[方法]以ERCP、bile duct stone recurrence、risk factor等为检索词,检索PubMed、Cochrane Library、中国期刊全文等数据库。应用Revman5.3软件进行Meta分析。[结果]合并十二指肠乳头旁憩室较无合并十二指肠乳头旁憩室患者(OR=1.60,95%CI:1.19~2.14,P<0.05)、胆总管扩张增粗较无胆总管扩张增粗患者(OR=3.76,95%CI:2.04~6.94,P<0.05)ERCP取石后胆总管结石复发率显著增加,差异均有统计学意义;合并多发结石患者较无合并多发结石患者ERCP取石后胆总管结石复发差异无统计学意义(OR=0.87,95%CI:0.42~1.80,P>0.05)。[结论]合并十二指肠乳头旁憩室、胆总管扩张增粗为ERCP取石后结石复发的危险因素。

[Objective]This study intends to evaluate related risk factors of bile duct stone recurrence af ter endoscopic retrograde cholangio-pancreatography（ERCP）through the method of Meta analysis. [Meth- ods]Databases including PubMed, EMBASE, the Cochrane Library, Chinese journal full-text database and Chinese biomedical literature database were searched with key words including ERCP,long time complication, bile duct stone recurrence and risk factor. Evaluation criteria for inclusion and exclusion of the studies were set through literature review. The quality of the literatures was evaluated through NOS literature e- valuation. All data were analyzed by using the RevMan 5.3 software. [Results]A total of 10 studies were included,accumulative total sample size of 2 874 cases. Meta analysis results showed that the stone recur- rent race after ERCP in patients with the periampullar diverticulaand common bile duct expansion increased significantly,compared to the patients without the periampullar diverticular common bile duct expansion, difference was statistically significant （OR = 1.60,95% C I ： 1.19 --2.14, P 〈0. 05 ; OR = 3.76,95% C I ： 2.04--6.94, P〈0.05）. In multiple stones group, there was no statistically significant difference compared to the solitary stone group（OR=0.87,95% CI：0. 42-- 1.80, P〉0.05）. [Conclusion]Periampullar diverticular,common bile duct expansion are the risk factors for calculi recurrence after ERCP.