胆总管结石内镜下十二指肠括约肌切开术后预防性胆囊切除术疗效的Meta分析

Efficacy of prophylactic cholecystectomy after endoscopic sphincterotomy on patients with choledocholithiasis: a Meta-analysis

目的系统评价胆总管结石内镜下十二指肠括约肌切开术(EST)后预防性胆囊切除术的疗效。方法计算机检索国际数据库PubMed、Embase、Cochrane Library以及国内数据库CNKI、VIP、CBM和WanFang,搜集有关EST术后预防性胆囊切除术的随机对照研究和回顾性研究,检索时间为建库至2020年12月。由2名研究者独立筛选文献、提取资料并对纳入研究进行质量评价,采用Stata 12.0软件进行Meta分析。结果最终纳入12项研究,共13 748例患者。Meta分析结果显示,与胆囊保留组相比,预防性胆囊切除术可以显著降低患者病死率(RR 0.58,95%CI 0.44~0.77,P<0.001),降低胰腺炎发生率(RR 0.37,95%CI 0.27~0.52,P<0.001)和胆管炎发生率(RR 0.34,95%CI 0.29~0.41,P<0.001)。结论胆总管结石内镜下十二指肠括约肌切开术后预防性胆囊切除术可有效改善胆总管结石患者的预后。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

objective To systematically review the efficacy of prophylactic cholecystectomy after endoscopic sphincterotomy (EST) on patients with choledocholithiasis.Methods Databases Pub Med,Embase,Cochrane Library,CNKI,VIP,CBM and Wan Fang were used to search retrospective studies and randomized controlled trials about the efficacy of prophylactic cholecystectomy after EST on patients with choledocholithiasis.The retrieval time was from the inception of the database to Dec.2020.Two researchers independently screened literature,extracted and assessed the quality of the included studies.Stata 12.0 software was used to perform Meta-analysis.Results A total of 12 studies were included that contained 13 748 patients.Meta-analysis showed that,compared with deferral cholecystectomy,prophylactic cholecystectomy could decrease the risk of mortality (RR 0.58,95%CI 0.44-0.77,P<0.001),decrease the incidence of pancreatitis (RR 0.37,95%CI 0.27-0.52,P<0.001) and the incidence of cholangitis (RR 0.34,95%CI 0.29-0.41,P<0.001).Conclusion Prophylactic cholecystectomy after endoscopic sphincterotomy can effectively improve the prognosis of patients with choledocholithiasis.Due to the limited quality and quantity of included studies,more high-quality studies are needed to verify the above conclusion.