直接行腹腔镜胆囊切除术与联合经皮经肝胆囊穿刺引流治疗急性重症胆囊炎的荟萃分析

Laparoscopic cholecystectomy with or without percutaneous transhepatic gallbladder drainage for acute severe cholecystitis:a meta-analysis

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.