腹腔镜与内镜联合治疗胆囊结石合并胆总管结石的Meta分析

Meta-analysis of Laparoscopic Common Bile Duct Exploration and Endoscopic Retrograde Cholangiopancreatography Combined with Laparoscopic Cholecystectomy for Gallstones Complicated with Common Bile Duct Stones

目的:采用循证医学方法对腹腔镜与内镜治疗胆囊结石合并胆总管结石的安全性和有效性进行客观分析。方法:计算机检索PubMed、Embase、Web of Science、Cochrane library和CNKI数据库,筛选出有效数据后采用Review Manager 5.3软件进行比较分析。结果:共纳入8篇文献,共有861例患者,其中LCBDE+LC组433例,术前ERCP+LC组428例。与术前ERCP+LC相比,LCBDE+LC组胆总管结石清除率显著升高(OR=1.83,95%CI:1.15~2.91,P<0.05);术后胆漏率显著升高(OR=2.92,95%CI:1.39~6.15,P<0.05);术后胰腺炎发生率显著降低(OR=0.18,95%CI:0.06~0.50,P<0.05)。结论:LCBDE+LC与术前ERCP+LC治疗胆囊结石合并胆总管结石均可有效清除结石,LCBDE+LC复发风险低,术后并发症少,术后恢复快,具有一定优势。

Objective To objectively analyze the safety and effectiveness of laparoscopic and endoscopic treatment of gallbladder stones with common bile duct stone by evidence-based medicine.Methods The PubMed,Embase,Web of Science,Cochrane library and CNKI databases were searched by computer.The valid data was selected and compared using Review Manager 5.3 software.Results A total of 8 articles were included,with a total of 861 patients,including 433 in the LCBDE+LC group and 428 in the preoperative ERCP+LC group.Compared with preoperative ERCP+LC,the clearance rate of common bile duct stones in LCBDE+LC group was significantly increased(OR=1.83,95%CI:1.15~2.91,P<0.05).The postoperative bile leakage rate in LCBDE+LC group was significantly increased.High(OR=2.92,95%CI:1.39~6.15,P<0.05).The incidence of postoperative pancreatitis was significantly lower(OR=0.18,95%CI:0.06~0.50,P<0.05).Conclusion LCBDE+LC combined with preoperative ERCP+LC for the treatment of gallstones combined with common bile duct stones can effectively remove stones.The LCBDE+LC method has a low risk of recurrence,less postoperative complications and quick recovery after surgery.