摘要
目的比较经皮经肝胆囊穿刺引流术(PTGD)后实施腹腔镜胆囊切除术(LC)与直接行LC治疗急性重症胆囊炎的临床疗效。方法依据纳入和排除标准,共筛选出23篇文献。对于纳入的文献采用荟萃分析法,对两种方法的临床疗效进行分析。结果PTGD联合LC的手术各项指标均好于直接行LC(均P≤0.05):手术时间:95%CI(-27.24,-9.27);术中出血量:95%CI(-50.25,-40.19);术后住院时间:95%CI(-3.63,-0.64);中转开腹率:OR=0.48,95%CI(0.32,0.74);切口感染率:OR=0.49,95%CI(0.25,0.99);术后留置腹腔引流管时间:95%CI(-2.07,-1.19);胃肠道功能恢复时间:95%CI(-1.73,-0.77);胆漏发生率:OR=0.23,95%CI(0.12,0.44);并发症总发生率:OR=0.36,95%CI(0.27,0.48)。结论PTGD联合LC的效果优于直接行LC,是治疗急性重症胆囊炎的可行、有效的方法。
Objective To compare laparoscopic cholecystectomy(LC)with or without percutaneous transhepatic gallbladder drainage(PTGD)for acute severe cholecystitis.Methods According to the predefined inclusion and exclusion criteria,23 articles were selected for this meta-analysis.All patients were treated with LC with or without PTGD.A meta-analysis was used to analyze the clinical efficacy.Results Compared with LC,all the surgical indicators of LC with PTGD were significantly better than LC alone(all P≤0.05),including the operation time:95%CI(-27.24,-9.27);intraoperative blood loss:95%CI(-50.25,-40.19);postoperative hospital stay:95%CI(-3.63,-0.64);rates of conversion to open abdomen:OR=0.48,95%CI(0.32,0.74);rates of incision infection:OR=0.49,95%CI(0.25,0.99);drainage tube indwelling time:95%CI(-2.07,-1.19);gastrointestinal function recovery time:95%CI(-1.73,-0.77);rates of bile leakage:OR=0.23,95%CI(0.12,0.44);and rates of complications:OR=0.36,95%CI(0.27,0.48).Conclusion Compared with LC alone,PTGD+LC is the preferred treatment for acute severe cholecystitis.
作者
张崇
沈思思
王明辉
刘吉盛
田学昌
Zhang Chong;Shen Sisi;Wang Minghui;Liu Jisheng;Tian Xuechang(Department of General Surgery,Ansteel Group Hospital,Anshan 114000,Liaoning Province,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2019年第12期910-914,共5页
Chinese Journal of Hepatobiliary Surgery
关键词
胆囊炎
急性
胆囊切除术
腹腔镜
治疗结果
经皮经肝胆囊穿刺引流术
荟萃分析
Cholecystitis,acute
Cholecystectomy,laparoscopic
Treatment outcome
Percutaneous transhepatic gallbladder drainage
Meta-analysis