LC+LCBDE和ERCP/EST+LC治疗胆囊结石合并胆总管结石疗效的Meta分析

Efficacy of LC + LCBDE and ERCP/EST + LC in the treatment of cholecystolithiasis and choledocholithiasis: a meta-analysis

目的系统评价腹腔镜胆囊切除术(LC)联合胆总管探查取石与内镜逆行胰胆管造影(ERCP)/内镜下十二指肠乳头括约肌切开取石术(EST)联合LC治疗胆囊结石合并胆总管结石的有效性及安全性。方法在Pub Med、EMbase、Cochrane图书馆、中国知网、万方等数据库中检索2010年1月至2018年12月发表的比较LC+LCBDE和ERCP/EST+LC疗效的临床随机对照试验(RCT),按照纳入排除标准进行文献筛选和质量评估后确定纳入文献,阅读文献全文提取相关研究资料,采用Rev Man5. 3软件进行数据分析。结果最终纳入10篇文献,包括1 502例病例,其中LC+LCBDE组756例,ERCP/EST+LC组746例。Meta分析结果示:LC+LCBDE组和ERCP/EST+LC组总并发症率无统计学差异(P> 0. 05),在并发症类型上,LC+LCBDE组术后胰腺炎、胆管炎、出血发生较多,LC+LCBDE组胆漏发生较多。两种术式在结石清除率、中转开腹率、手术时间、住院时间等方面均无统计学差异(P均> 0. 05)。结论 LC+LCBDE与ERCP/EST+LC两种微创术式具有相似的有效性及安全性,两者有各自发生较多的相关并发症,在手术时间及住院时间上均未呈现明显差异,LC+LCBDE组在住院费用上稍具优越性。以上结论尚需进行更多前瞻性RCT进行验证及更新。

Objective combined with laparoscopic common bile duct exploration( LCBDE) and endoscopic retrograde cholangiopancreatography( ERCP)/endoscopic sphincterotomy( EST) combined LC for patients with cholecystolithiasis and choledocholithiasis.Methods Randomized controlled trial( RCT) comparing the efficacy of LC + LCBDE and ERCP/EST + LC published from January 2010 to December 2018 was searched in databases such as Pub Med,Embase,Cochrane Library,China National Knowledge Infrastructure,and Wanfang database. Literature screening was performed according to the inclusion and exclusion criteria. The full text of the literature was read to extract relevant research data. Data analysis was performed using RevMan5. 3 software. Results A total of 10 literatures with 1 502 cases were included,of which 756 cases were in the LC + LCBDE group and 746 cases were in the ERCP/EST + LC group. Meta analysis showed that LC + LCBDE group and ERCP/EST + LC group had no statistically significant difference in the total complication rate( P > 0. 05). In terms of the type of complications,the pancreatitis,cholangitis and bleeding in the LC + LCBDE group occurred more frequently,while bile leakage occurred more frequently in the LC + LCBDE group. There were no significant differences in the stone removal rate,conversion rate of laparotomy,operation time,and length of hospital stay between the two groups( all P >0. 05). Conclusions LC + LCBDE and ERCP/EST + LC have similar effectiveness and safety. Both of them have many related complications,and there is no significant difference in operation time and hospital stay. The LC + LCBDE group is slightly superior in hospitalization costs. The above conclusions need to be verified and updated with more forward RCTs.