早期及延期腹腔镜胆囊切除术治疗轻型胆源性胰腺炎的meta分析

The therapeutic effect of early and delayed laparoscopic cholecystectomy in the treatment of mild biliary pancreatitis:a meta-analysis

目的:系统评价早期腹腔镜胆囊切除术(E-LC)与延期腹腔镜胆囊切除术(D-LC)应用于轻度急性胆源性胰腺炎患者的临床疗效。方法:根据研究目的制订文献纳入与排除标准,在此基础上检索文献数据库,收集从建库至2020年5月发表的有关E-LC与D-LC治疗轻度急性胆源性胰腺炎的临床随机对照研究(RCT)。文献筛选、质量评估与数据提取由两名研究人员各自同时进行,结局指标包括手术时间、住院时间、并发症发生率、中转开腹率、再入院率等,将纳入的文献数据整理后采用RevMan 5.3软件进行Meta分析。结果:共纳入8篇RCT文献,包括785例患者,其中E-LC组398例,D-LC组387例。Meta分析结果显示,E-LC组与D-LC组患者在围手术期ERCP干预、手术时间、手术难度评分、中转开腹率、术后住院时间等方面差异无统计学意义。但E-LC组总住院时间更短[SMD=-2.07,95%CI(-3.22,-0.93),P=0.0004],再入院率更低[RR=0.25,95%CI(0.12,0.53),P=0.0003],包括胆绞痛等症状在内的并发症发生率更低[RR=0.18,95%CI(0.13,0.24),P<0.00001],尤其等待手术期间的并发症[RR=0.04,95%CI(0.02,0.10),P<0.00001]。结论:在轻度急性胆源性胰腺炎的治疗中,E-LC能缩短总住院时间,降低并发症发生率,改善预后,且不增加手术难度。如患者身体情况允许,建议行E-LC。

Objective:To systematically evaluate the application effect of early laparoscopic cholecystectomy(E-LC)and delayed laparoscopic cholecystectomy(D-LC)in the treatment of mild acute biliary pancreatitis.Methods:Several major literature databases were electronically searched based on the inclusion and exclusion criteria established for research purposes.The clinical randomized controlled trials(RCT),which published from databases established to May 2020 and met the inclusion criteria,were collected.Literature screening,quality assessment and data extraction were carried out independently by two researchers at the same time,and outcome indicators included the duration of surgery,hospitalization time,incidence of complications,rate of conversion to laparotomy and readmission.Meta analysis was conducted on the included literature data by using RevMan 5.3 software.Results:A total of eight RCTs were included in this analysis,which contained clinical data of 785 patients,with 398 patients in the E-LC group and 387 patients in the D-LC group.The meta-analysis results showed that there was no statistical difference between the two groups in terms of perioperative ERCP operations,operative time,difficulty score of surgery,rate of conversion to laparotomy,or postoperative hospital stay.In the E-LC group,however,the total hospital stay was shorter[SMD=-2.07,95%CI(-3.22,-0.93),P=0.0004]and readmission rate was lower[RR=0.25,95%CI(0.12,0.53),P=0.0003],while the incidence of complications including biliary colic and other symptoms was lower[RR=0.18,95%CI(0.13,0.24),P<0.00001],especially complications occurred during preoperative waiting[RR=0.04,95%CI(0.02,0.10),P<0.00001].Conclusions:In the treatment of mild acute biliary pancreatitis,E-LC can reduce the total hospital stay and incidence of complications,and improve the prognosis without increasing the surgical difficulty.Therefore,E-LC for mild acute biliary pancreatitis is recommended if the patient's condition permits.