减重与代谢手术后胆石形成的荟萃分析

A meta-analysis of cholelithiasis after metabolic and bariatric surgery

目的Meta分析Roux-en-Y胃旁路术(RYGB)和胃袖状切除术(SG)后胆结石的发病率。方法以"bariatric surgery、gastric bypass、Roux-n-Y gastric bypass、RYGB、sleeve gastrectomy、SG、cholelithiasis、cholecystectomy、gallstone"为英文检索词。检索Pubmed、Medline和Embase数据库中截至2023年2月的文献,并用纽卡斯尔-渥太华量表(NOS)对文献进行质量评价,得到的数据采用Revman 5.4软件分析。结果共检索到9篇相关的队列研究文献,共纳入24255例RYGB患者和4500例SG患者,经过NOS的质量评价后均符合要求。Meta分析显示整体上RYGB组术后胆结石的发病率要高于SG组(P<0.001)。在亚组分析中,使用熊脱氧胆酸(UDCA)进行预防后,两组胆结石发病率差异无统计学意义(P=0.090),而在未使用预防措施的研究中,RYGB术后胆结石发病率高于SG(P=0.005);术后随访时间在24个月内的研究中,RYGB组术后胆结石发病率高于SG组(P=0.050),超过24个月则两组差异无统计学意义(P=0.240)。结论术后2年内,RYGB患者胆结石的发病率高于SG患者,而术后远期两组胆结石发病率无显著差异,术后常规应用UDCA可有效降低RYGB术后胆结石的发生。

Objective To analyze the incidence of gallstone formation after Roux-en-Y gastric bypass(RYGB)and sleeve gastrectomy(SG)by meta-analysis.Methods English terms for this meta-analysis included"bariatric surgery,gastric bypass,Roux-n-Y gastric bypass,RYGB,sleeve gastrectomy,SG,cholelithiasis,cholecystectomy,gallstone".Researched articles in Pubmed,Medline and Embase databases were searched up to February 2023 and retrieved for further analysis.The quality of each article was evaluated with Newcastle-Ottawa Scale(NOS).Generated data were analyzed with Revman 5.4.Results Nine relevant cohort studies were retrieved for this meta-analysis,including a total of 24255 RYGB patients and 4500 SG patients.All articles met the requirements after the quality evaluation of NOS.The meta-analysis results showed that the incidence of postoperative gallstones in RYGB group was higher than that in SG group(P<0.001).In subgroup analysis,by administering ursodeoxycholic acid(UDCA)for gallstone prevention,the incidence had no difference between the two groups(P=0.090),while in the study without UDCA,the incidence of gallstones after RYGB was higher than SG(P=0.005).In the studies with follow-up time no more than 24 months,the incidence of postoperative gallstones in RYGB group was higher than that in SG group(P=0.050),but there was no statistical difference when following-up beyond 24 months(P=0.240).Conclusions Within 2 years after surgery,RYGB patients have more chances to develop gallstones than SG patients.However,beyond 2-year follow-up,there is no difference between the two procedures.Prophylactical utilization of UDCA after RYGB can effectively reduce the incidence of gallstone formation.