内镜括约肌切开联合腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的Meta分析被引量：32

A Meta-analysis of endoscopic sphincterotomy plus laparoscopic cholecystectomy for concomitant gallstones with common bile duct stones

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摘要目的系统评价腹腔镜胆囊切除术(laparoscopic cholecystectomy, LC)联合腹腔镜胆总管探查术(laparoscopic common bile duct exploration, LCBDE)与内镜下括约肌切开(endoscopic sphincterotomy, EST)联合LC治疗胆囊结石合并胆总管结石的安全性和有效性。方法检索Cochrane Library、PubMed、CNKI、万方数据库,查找出版日期截至2018年4月的公开发表的关于LC+LCBDE和EST+LC治疗胆囊结石合并胆总管结石的随机对照试验(random controlled trail,RCT),应用RevMan 5.3软件进行Meta分析。结果纳入9项随机对照试验,合计1 154例患者。Meta分析结果表明,两种术式相比,EST+LC能够降低残石率(RR=2.35,95%CI:1.33～4.13,P=0.003),LC+LCBDE能缩短住院天数(WMD=-0.70,95%CI:-1.14～-0.25,P=0.002);两种术式在胆总管结石清除率(RR=0.98,95%CI:0.92～1.04,P=0.44)、手术中转率(RR=1.12,95%CI:0.73～1.70,P=0.60)、并发症发生率(RR=1.00,95%CI:0.77～1.31,P=1.00)及手术时间(WMD=0.89,95%CI:-15.20～16.98,P=0.91)差异无统计学意义。结论 EST+LC治疗胆囊结石合并胆总管结石有较好的安全性及有效性。 Objective To compare the efficacy and safety of laparoscopic cholecystectomy(LC)plus laparoscopic common bile duct stones exploration(LCBDE)and LC plus endoscopic sphincterotomy(EST)in the treatment of concomitant gallstones with common bile duct stones patients.Methods Cochrane Library,PubMed,CNKI and Wanfang were searched to identify randomized controlled trails(RCTs)published before Apr.2018 between the LC+LCBDE and EST+LC in treatment of gallstone concomitant gallstones with common bile duct stones.Meta analysis was conducted by the RevMan 5.3.Results A total of 9 RCTs involving 1 154 patients were included in this Meta-analysis.Meta-analysis showed there was no difference in CBD stone clear rate(RR=0.98,95%CI:0.92-1.04,P=0.44),conversion rate(RR=1.12,95%CI:0.73-1.70,P=0.60),incidence of complications(RR=1.00,95%CI:0.77-1.31,P=1.00)and operative time(WMD=0.89,95%CI:-15.20-16.98,P=0.91)between two procedures.LC+LCBDE had less length of hospital stay(WMD=-0.70,95%CI:-1.14--0.25,P=0.002)and higher retained stones rate(RR=2.35,95%CI:1.33-4.13,P=0.003)than EST+LC.Conclusion EST+LC has relatively good efficacy and safety in treatment of concomitant gallstone with common bile duct stones.

作者汤普森刘正昊崔君鹏刘宝林 TANG Pusen;LIU Zhenghao;CUI Junpeng;LIU Baolin(Department of General Surgery,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区中国医科大学附属盛京医院普外科

出处《胃肠病学和肝病学杂志》 CAS 2019年第4期410-416,共7页 Chinese Journal of Gastroenterology and Hepatology

关键词腹腔镜胆囊切除术胆总管探查内镜下括约肌切开 META分析 Laparoscopy Cholecystectomy Common bile duct exploration Endoscopic sphincterotomy Meta analysis

分类号 R575.7 [医药卫生—消化系统]

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1李宇,郝杰,孙昊,王林,仵正,王铮,陶杰,杨雪.一期腹腔镜胆囊切除联合胆总管探查取石与分期内镜取石和腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的比较[J].中国普通外科杂志,2016,25(2):202-208. 被引量：118
2Ioannis Baloyiannis,George Tzovaras.Current status of laparoendoscopic rendezvous in the treatment of cholelithiasis with concomitant choledocholithiasis[J].World Journal of Gastrointestinal Endoscopy,2015,7(7):714-719. 被引量：10

二级参考文献41

1Lella F, Bagnolo F, Rebuffat C, Scalambra M, Bonassi U, ColomboE. Use of the laparoscopic-endoscopic approach, the so-called“rendezvous” technique, in cholecystocholedocholithiasis: a validmethod in cases with patient-related risk factors for post-ERCPpancreatitis. Surg Endosc 2006; 20: 419-423 [PMID: 16424987].
2Rosenthal RJ, Rossi RL, Martin RF. Options and strategies forthe management of choledocholithiasis. World J Surg 1998; 22:1125-1132 [PMID: 9828720].
3Targarona EM, Bendahan GE. Management of common bile ductstones: controversies and future perspectives. HPB (Oxford) 2004; 6:140-143 [PMID: 18333067].
4Tranter SE, Thompson MH. Comparison of endoscopicsphincterotomy and laparoscopic exploration of the common bileduct. Br J Surg 2002; 89: 1495-1504 [PMID: 12445057].
5Basso N, Pizzuto G, Surgo D, Materia A, Silecchia G, Fantini A, Fiocca F, Trentino P. Laparoscopic cholecystectomy andintraoperative endoscopic sphincterotomy in the treatment ofcholecysto-choledocholithiasis. Gastrointest Endosc 1999; 50:532-535 [PMID: 10502176].
6Neoptolemos JP, Carr-Locke DL, Fossard DP. Prospectiverandomised study of preoperative endoscopic sphincterotomyversus surgery alone for common bile duct stones. Br Med J (ClinRes Ed) 1987; 294: 470-474 [PMID: 3103731].
7Stain SC, Cohen H, Tsuishoysha M, Donovan AJ. Choledocholithiasis.Endoscopic sphincterotomy or common bile ductexploration. Ann Surg 1991; 213: 627-633; discussion 633-634[PMID: 2039294].
8Morino M, Baracchi F, Miglietta C, Furlan N, Ragona R,Garbarini A. Preoperative endoscopic sphincterotomy versuslaparoendoscopic rendezvous in patients with gallbladder and bileduct stones. Ann Surg 2006; 244: 889-893; discussion 893-896[PMID: 17122614].
9Iodice G, Giardiello C, Francica G, Sarrantonio G, AngeloneG, Cristiano S, Finelli R, Tramontano G. Single-step treatmentof gallbladder and bile duct stones: a combined endoscopiclaparoscopictechnique. Gastrointest Endosc 2001; 53: 336-338[PMID: 11231394].
10Cuschieri A, Lezoche E, Morino M, Croce E, Lacy A, Toouli J,Faggioni A, Ribeiro VM, Jakimowicz J, Visa J, Hanna GB. E.A.E.S.multicenter prospective randomized trial comparing two-stage vssingle-stage management of patients with gallstone disease andductal calculi. Surg Endosc 1999; 13: 952-957 [PMID: 10526025].