AIM: To assess endoscopic papillary balloon dilatation (EPBD) and endoscopic sphincteropapillotomy (EST) for common bile duct (CBD) stone removal using a meta-analysis. METHODS: Randomized controlled trials published ...AIM: To assess endoscopic papillary balloon dilatation (EPBD) and endoscopic sphincteropapillotomy (EST) for common bile duct (CBD) stone removal using a meta-analysis. METHODS: Randomized controlled trials published from 1990 to 2012 comparing EPBD with EST for CBD stone removal were evaluated. This meta-analysis was performed to estimate short-term and long-term com-plications of these two treatments. The fixed random effect model or random effect model was established to analysis the data. Results were obtained by analyz-ing the relative risk, odds ratio, and 95%CI for a given comparison using RevMan 5.1. Statistical significance was defined asP < 0.05. Risk of bias was evaluated us-ing a funnel plot. RESULTS: Of the 1975 patients analyzed, 980 of them were treated with EPBD and 995 were treated with EST. Of the patient population, patients in the EPBDgroup were younger (OR=-1.16, 95%CI:-1.49 to 0.84, P<0.01). There were no significant differences in gender proportion, average size of stones, number of gallstones, previous cholecystectomy, the incidence of duodenal diverticulum, CBD diameter or the total follow-up time between EST and EPBD groups. Com-pared with EST, the total stone clearance in the EPBD group decreased (OR=0.64, 95%CI: 0.42 to 0.96,P=0.03), the use of stone extraction baskets significantly increased (OR=1.91, 95%CI: 1.41 to 2.59, P<0.01), and the incidence of pancreatitis significantly increased (OR=2.79, 95%CI: 1.74 to 4.45, P<0.0001). The incidence of bleeding (OR=0.12, 95%CI: 0.04 to 0.34, P<0.01) and cholecystitis (OR=0.41, 95%CI: 0.20 to 0.84, P=0.02) significantly decreased. The stone re-currence rate also was significantly reduced in EPBD (OR=0.48, 95%CI: 0.26 to 0.90, P=0.02). There were no significant differences between the two groups with the incidence of stone removal at first attempt, hours of operation, total short-term complications and infection, perforation, or acute cholangitis. CONCLUSION: Although the incidence of pancreatitis was higher, the overall stone clearance rate and risk of bleeding was lower with EPBD compared to EST.展开更多
目的探讨胆总管结石合并胆囊结石老年患者的治疗方案的选择及疗效。方法回顾性分析2017年2月至2019年11月于平度市人民医院确诊为胆囊结石合并胆总管结石66例老年患者资料,根据手术方式不同分成观察组(n=34)和对照组(n=32),观察组采用...目的探讨胆总管结石合并胆囊结石老年患者的治疗方案的选择及疗效。方法回顾性分析2017年2月至2019年11月于平度市人民医院确诊为胆囊结石合并胆总管结石66例老年患者资料,根据手术方式不同分成观察组(n=34)和对照组(n=32),观察组采用分步内镜下乳头括约肌切开术(endoscopic sphincteropapillotomy,EST)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗,对照组采用LC联合腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration T-tube choledochotomy,LCBDE)治疗。比较两组的总手术时间、术后引流管留置时间、术中出血量、术后住院时间、腹腔镜中转开腹、结石清除率、术后并发症(包括发热、胆漏、胰腺炎)。结果观察组患者的总手术时间、引流管留置时间、术后住院时间均短于对照组,术中出血量少于对照组,术中中转开腹率低于对照组,差异均有显著性(P<0.05)。两组患者的结石清除率及术后并发症发生率无显著差异(P>0.05)。结论EST+LC和LC+LCBDE均能较好地治疗老年患者胆囊结石合并胆总管结石,但在医师技术和手术设备均具备的条件下,选择EST+LC治疗胆总管结石合并胆囊结石对老年患者更加有益。展开更多
文摘AIM: To assess endoscopic papillary balloon dilatation (EPBD) and endoscopic sphincteropapillotomy (EST) for common bile duct (CBD) stone removal using a meta-analysis. METHODS: Randomized controlled trials published from 1990 to 2012 comparing EPBD with EST for CBD stone removal were evaluated. This meta-analysis was performed to estimate short-term and long-term com-plications of these two treatments. The fixed random effect model or random effect model was established to analysis the data. Results were obtained by analyz-ing the relative risk, odds ratio, and 95%CI for a given comparison using RevMan 5.1. Statistical significance was defined asP < 0.05. Risk of bias was evaluated us-ing a funnel plot. RESULTS: Of the 1975 patients analyzed, 980 of them were treated with EPBD and 995 were treated with EST. Of the patient population, patients in the EPBDgroup were younger (OR=-1.16, 95%CI:-1.49 to 0.84, P<0.01). There were no significant differences in gender proportion, average size of stones, number of gallstones, previous cholecystectomy, the incidence of duodenal diverticulum, CBD diameter or the total follow-up time between EST and EPBD groups. Com-pared with EST, the total stone clearance in the EPBD group decreased (OR=0.64, 95%CI: 0.42 to 0.96,P=0.03), the use of stone extraction baskets significantly increased (OR=1.91, 95%CI: 1.41 to 2.59, P<0.01), and the incidence of pancreatitis significantly increased (OR=2.79, 95%CI: 1.74 to 4.45, P<0.0001). The incidence of bleeding (OR=0.12, 95%CI: 0.04 to 0.34, P<0.01) and cholecystitis (OR=0.41, 95%CI: 0.20 to 0.84, P=0.02) significantly decreased. The stone re-currence rate also was significantly reduced in EPBD (OR=0.48, 95%CI: 0.26 to 0.90, P=0.02). There were no significant differences between the two groups with the incidence of stone removal at first attempt, hours of operation, total short-term complications and infection, perforation, or acute cholangitis. CONCLUSION: Although the incidence of pancreatitis was higher, the overall stone clearance rate and risk of bleeding was lower with EPBD compared to EST.
文摘目的探讨胆总管结石合并胆囊结石老年患者的治疗方案的选择及疗效。方法回顾性分析2017年2月至2019年11月于平度市人民医院确诊为胆囊结石合并胆总管结石66例老年患者资料,根据手术方式不同分成观察组(n=34)和对照组(n=32),观察组采用分步内镜下乳头括约肌切开术(endoscopic sphincteropapillotomy,EST)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗,对照组采用LC联合腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration T-tube choledochotomy,LCBDE)治疗。比较两组的总手术时间、术后引流管留置时间、术中出血量、术后住院时间、腹腔镜中转开腹、结石清除率、术后并发症(包括发热、胆漏、胰腺炎)。结果观察组患者的总手术时间、引流管留置时间、术后住院时间均短于对照组,术中出血量少于对照组,术中中转开腹率低于对照组,差异均有显著性(P<0.05)。两组患者的结石清除率及术后并发症发生率无显著差异(P>0.05)。结论EST+LC和LC+LCBDE均能较好地治疗老年患者胆囊结石合并胆总管结石,但在医师技术和手术设备均具备的条件下,选择EST+LC治疗胆总管结石合并胆囊结石对老年患者更加有益。
