急性重症胆囊炎PTGD后再行腹腔镜胆囊切除术最佳时机的Meta分析

Appropriate interval from percutaneous transhepatic gallbladder drainage to laparoscopic cholecystectomy for acute cholecystitis:A Meta-analysis

目的:比较急性重症胆囊炎先行经皮经肝胆囊穿刺引流术(PTGD)后再行腹腔镜胆囊切除术(LC)的临床效果,为合理选择PTGD术后行LC手术时机提供理论依据。方法:依据纳入标准和排除标准共筛选出14篇文献,均为先应用PTGD,术后2个月内与2个月后行LC治疗急性重症胆囊炎的临床研究;采用Meta分析法,对其临床疗效进行分析研究。结果:经过Meta分析,对比手术时间、术中出血量、术后住院时间、中转开腹率、术后留置腹腔引流管时间、胃肠道功能恢复时间、术前胆囊壁厚度、术后并发症总发生率。(1)手术时间:95%CI(17.16~27.36),P<0.00001;(2)术中出血量:95%CI(17.20~38.20),P<0.00001;(3)术后住院时间:95%CI(1.96~4.91),P<0.00001;(4)中转开腹率:OR=6.73,95%CI(4.02~11.26),P<0.00001;(5)术后留置腹腔引流管时间:95%CI(0.42~3.04),P=0.010;(6)胃肠道功能恢复时间:95%CI(5.38~7.72),P<0.00001;(7)术前胆囊壁厚度:95%CI(0.07~0.16),P<0.00001;(8)术后并发症总发生率:OR=3.91,95%CI(2.54~6.01),P<0.00001;结论:急性胆囊炎行PTGD后2个月后行LC效果更优,值得临床推广。

Objective:To evaluate the comparative therapeutic efficacy of the appropriate interval from percutaneous transhepatic gallbladder drainage to laparoscopic cholecystectomy acute severe cholecystitis,and provid a basis for different operation time selection.Methods:According to the inclusion criteria and exclusion criteria,14 articles were selected.All patients were treated with percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy.Laparoscopic cholecystectomy was performed within 2 months or 2 months after PTGD for acute severe cholecystitis.According to the14 articles,a meta-analysis was used to analyze the clinical efficacy.Results:Based on Meta-analysis,comparative analysis included operation time,intraoperative blood loss,postoperative hospital time,the rates of laparoscopic cholecystectomy(LC)conversion to laparotomy,drainage tube indwelling time,gastrointestinal function recovery time,preoperative gallbladder wall thickness,the rates of all complications.(1)operation time:95%CI(17.16,27.36),P<0.00001;(2)intraoperative blood loss:95%CI(17.20,38.20),P<0.00001;(3)postoperative hospital time:95%CI(1.96,4.91),P<0.00001;(4)the rates of laparoscopic cholecystectomy(LC)conversion to laparotomy:OR=6.73,95%CI(4.02,11.26),P<0.00001;(5)drainage tube indwelling time:95%CI(0.42,3.04),P=0.010;(6)gastrointestinal function recovery time:95%CI(5.38,7.72),P<0.00001;(7)preoperative gallbladder wall thickness:95%CI(0.07,0.16),P<0.00001;(8)the rates of all complications:OR=3.91,95%CI(2.54,6.01),P<0.00001.Conclusion:The results indicate that more than 2 months interval from PTGD to LC is superior,and would be the preferred method for acute severe cholecystitis.