分期腹腔镜手术探查对胆囊癌及肝门部胆管癌诊断价值的荟萃分析

Diagnostic staging laparoscopy in gallbladder carcinoma and hilar cholangiocarcinoma:a meta-analysis

目的探讨分期腹腔镜手术(SL)对胆囊癌(GBC)及肝门部胆管癌(HC)患者的诊断价值。方法检索Medline,Embase,Web of Science,Cochrane图书馆和Google学术有关SL探查在GBC及HC诊断中应用的相关文献进行汇总、归纳和统计学分析,评估其敏感性、特异性和诊断的优势。结果经过筛选,8篇文献符合纳入标准。1062例SL患者中,有316例(29.8%)发现不可切除肿瘤,其中32.4%(153/472)为疑似HC,27.6%(163/590)为疑似GBC。HC的诊断敏感性为0.556(95%CI:0.495-0.616),GBC的诊断敏感性为0.642(95%CI:0.579-0.701)。本研究SL的总灵敏度和特异度分别为0.597(95%CI:0.554-0.639)和1.000(95%CI:0.993-1.000)。结论GBC及HC患者行SL联合术中超声,提高了诊断的准确性,使患者避免了不必要的开腹手术,值得进一步推广。

Objective To analyze the impact of diagnostic staging laparoscopy in gallbladder carcinoma and hilar cholangiocarcinoma.Methods The Medline,Embase,Web of Science,Cochrane library and Google Scholar were searched for literature on staging laparoscopy(SL)in gallbladder carcinoma and hilar cholangiocarcinoma.The sensitivity,specificity and diagnostic accuracy of SL were evaluated.Results Eight studies were included in the meta-analysis.During laparoscopy,unresectable disease was found in 316 of 1 062 patients(29.8% ),of whom 32.4% were patients with suspected hilar cholangiocarcinoma(HC)and 27.6% were patients with suspected gall-bladder cancer(GBC).The sensitivities were 0.556(95% CI:0.495–0.616)for patients with HC and 0.642(95% CI:0.579–0.701)for patients with GBC.The pooled specificity for SL was 100% (95% CI:0.993–1.000)for all the studies.Conclusion For patients with gallbladder cancer or hilar cholangiocarcinoma,SL combined with intraoperative ultrasound improved the accuracy of diagnosis and avoided unnecessary laparotomy.