早期腹腔镜胆囊切除术治疗轻型胆源性胰腺炎的Meta分析

Meta-analysis of early laparoscopic cholecystectomy for mild gallstone pancreatitis

目的系统评价和比较早期腹腔镜胆囊切除术和延迟腹腔镜胆囊切除术治疗轻型胆源性胰腺炎的安全性和有效性。方法通过检索外文数据库PubMed,Embase,Cochrane Library获取相关数据资料并纳入符合条件的研究,在质量评价后提取数据,并通过RevMan 5.3进行Meta分析。结果共纳入18项研究,包含1247例早期接受腹腔镜胆囊切除术的患者(早期组)和1303例延迟接受腹腔镜胆囊切除术的患者(延迟组)。早期组与延迟组比较,住院时间更短[MD=-2.14,95%CI(-2.87,-1.40),P<0.00001]、再入院率更低[RR=0.16,95%CI(0.05,0.55),P=0.0001]、经内镜逆行性胰胆管造影术率更低[RR=0.77,95%CI(0.65,0.92),P=0.003],两组之间在手术时间[MD=0.45,95%CI(-2.99,3.88),P=0.80]、术后并发症发生率[RR=0.62,95%CI(0.37,1.03),P=0.06]、中转开腹率[RR=1.16,95%CI(0.87,1.54),P=0.31]、病死率方面无显著差异。结论对于轻型胆源性胰腺炎,早期腹腔镜胆囊切除术是安全、有效的。

Objective To systematically evaluate and compare the safety and efficacy of early laparoscopic cholecystectomy(ELC)and delayed laparoscopic cholecystectomy(DLC)in patients with mild gallstone pancreatitis.Methods Relevant studies were obtained by searching the foreign language databases PubMed,Embase,and Cochrane Library,and eligible studies were included.After the quality evaluation,the data was extracted,and the Meta-analysis was performed through RevMan 5.3.Results A total of 18 studies were included,involving 1247 patients in ELC group and 1303 patients in DLC group.The ELC group was significantly correlated with lower length of hospital stay(MD=-2.14,95%CI-2.87 to 1.40,P<0.00001),lower readmission rate(RR=0.16,95%CI 0.05 to 0.55,P=0.0001)and lower ERCP rate(RR=0.77,95%CI 0.65 to 0.92,P=0.003).There was no significant difference in operative time(MD=0.45,95%CI-2.99 to 3.88,P=0.80),postoperative complications rate(RR=0.62,95%CI 0.37 to 1.03,P=0.06),rate of conversion to open cholecystectomy(RR=1.16,95%CI 0.87 to 1.54,P=0.31),and mortality rate between the ELC group and the DLC group.Conclusion Early laparoscopic cholecystectomy is safe and effective for patients with mild gallstone pancreatitis.