中国病人内镜取石后胆总管结石复发相关危险因素的Meta分析

Meta-analysis of risk factors of recurrence of common bile duct stones after endoscopic treatment in China

目的用循证医学的方法探讨中国病人内镜取石后胆总管结石复发的相关危险因素,为预测和预防结石复发提供理论依据。方法检索中国知网、维普和万方等数据库,收集自建库至2016年12月期间公开发表的有关内镜取石后胆总管结石复发危险因素的相关文献,运用固定或随机模型对各个因素进行合并分析。结果共纳入11项研究,6 137例内镜治疗病人。Meta分析结果显示,复发组中有胆道手术史的病人比例高于未复发组(OR=8.70,95%CI:5.22~14.50;P<0.01);复发组中有乳头旁憩室的病人比例高于未复发组中的病人(OR=3.14,95%CI:2.32~4.25;P<0.01);复发组中多发结石的病人比例高于未复发组(OR=1.57,95%CI:1.11~2.22;P<0.05);复发组中结石直径>10 mm的病人比例高于未复发组(OR=7.12,95%CI:4.98~10.19;P<0.01);复发组中碎石的病人比例高于未复发组(OR=2.03,95%CI:1.66~2.49;P<0.01)。结论既往有胆道手术史、合并乳头旁憩室、多发结石、结石直径>10 mm和机械碎石是内镜治疗后胆总管结石复发的危险因素。

Objective To investigate the risk factors of recurrence of common bile duct stones after endoscopic treatment in China by means of evidence-based medicine and to provide a theoretical basis for the prediction and prevention of recurrence of calculus.Methods The fixed-effects or random-effects model were performed on the studies on risk factors of recurrence of common bile duct stones after endoscopic treatment in patients published up to December 2016 by searching CNKI,VIP and Wanfang Database.Results A total of 11 studies involving 6 137 patients with endoscopic treatment were included in the meta-analysis.The rate of patients with a history of biliary tract surgery in recurrence group was higher than that in non-recurrence group（OR=8.70,95% CI：5.22-14.50;P〈0.01）.The rate of patients with periampullary diverticula in recurrence group was higher than that in non-recurrence group（OR=3.14,95% CI：2.32-4.25;P〈0.01）.The rate of patients with multiple stones in recurrence group was higher than that in non-recurrence group（OR=1.57,95% CI：1.11-2.22;P〈0.05）.The rate of patients with stones larger than 10 mm in recurrence group was higher than that in non-recurrence group（OR=7.12,95% CI：4.98-10.19;P〈0.01）.The rate of patients with lithotripsy in recurrence group was higher than that in non-recurrence group（OR=2.03,95% CI：1.66-2.49;P〈0.01）.Conclusions A history of biliary tract surgery,periampullary diverticula,multiple stones,stones larger than 10 mm and lithotripsy are risk factors of recurrence of common bile duct stones after endoscopic treatment.