AIM To perform a meta-analysis on laparoscopic hepatectomy VS conventional liver resection for treating hepatolithiasis.METHODS We conducted a systematic literature search on Pub Med,Embase,Web of Science and Cochrane...AIM To perform a meta-analysis on laparoscopic hepatectomy VS conventional liver resection for treating hepatolithiasis.METHODS We conducted a systematic literature search on Pub Med,Embase,Web of Science and Cochrane Library,and undertook a meta-analysis to compare the efficacy and safety of laparoscopic hepatectomy V S conventional open liver resection for local hepatolithiasis in the left or right lobe. Intraoperative and postoperative outcomes(time,estimated blood loss,blood transfusion rate,postoperative intestinal function recovery time,length of hospital stay,postoperative complication rate,initial residual stone,final residual stone and stone recurrence) were analyzed systematically.RESULTS A comprehensive literature search retrieved 16 publications with a total of 1329 cases. Meta-analysis of these studies showed that the laparoscopic approach for hepatolithiasis was associated with significantly less intraoperative estimated blood loss [weighted mean difference(WMD): 61.56,95% confidence interval(CI): 14.91-108.20,P = 0.01],lower blood transfusion rate [odds ratio(OR): 0.41,95%CI: 0.22-0.79,P = 0.008],shorter intestinal function recovery time(WMD: 0.98,95%CI: 0.47-1.48,P = 0.01),lower total postoperative complication rate(OR: 0.52,95%CI: 0.39-0.70,P < 0.0001) and shorter stay in hospital(WMD: 3.32,95%CI: 2.32-4.32,P < 0.00001). In addition,our results showed no significant differences between the two groups in operative time(WMD: 21.49,95%CI: 0.27-43.24,P = 0.05),residual stones(OR: 0.79,95%CI: 0.50-1.25,P = 0.31) and stone recurrence(OR: 0.34,95%CI: 0.11-1.08,P = 0.07). Furthermore,with subgroups analysis,our results proved that the laparoscopic approach for hepatolithiasis in the left lateral lobe and left side could achieve satisfactory therapeutic effects. CONCLUSION The laparoscopic approach is safe and effective,with less intraoperative estimated blood loss,fewer postoperative complications,reduced length of hospital stay and shorter intestinal function recovery time than with conventional approaches.展开更多
AIM To perform a systematic review and meta-analysis on clinical outcomes of photodynamic therapy(PDT) in non-resectable cholangiocarcinoma. METHODS Included studies compared outcomes with photodynamic therapy and bil...AIM To perform a systematic review and meta-analysis on clinical outcomes of photodynamic therapy(PDT) in non-resectable cholangiocarcinoma. METHODS Included studies compared outcomes with photodynamic therapy and biliary stenting(PDT group) vs biliary stenting only(BS group) in palliation of non-resectable cholangiocarcinoma. Articles were searched in MEDLINE, PubM ed, and EMBASE. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using the I2 statistic.RESULTS Ten studies(n = 402) that met inclusion criteria were included in this analysis. The P for χ2 heterogeneity for all the pooled accuracy estimates was > 0.10. Pooled odds ratio for successful biliary drainage(decrease in bilirubin level > 50% within 7days after stenting)in PDT vs BS group was 4.39(95%CI: 2.35-8.19).Survival period in PDT and BS groups were 413.04d(95%CI: 349.54-476.54) and 183.41(95%CI:136.81-230.02) respectively. The change in Karnofsky performance scores after intervention in PDT and BS groups were +6.99(95%CI: 4.15-9.82) and-3.93(95%CI:-8.63-0.77) respectively. Odds ratio for postintervention cholangitis in PDT vs BS group was 0.57(95%CI: 0.35-0.94). In PDT group, 10.51%(95%CI:6.94-14.72) had photosensitivity reactions that were self-limiting. Subgroup analysis of prospective studies showed similar results, except the incidence of cholangitis was comparable in both groups. CONCLUSION In palliation of unresectable cholangiocarcinoma, PDT seems to be significantly superior to BS alone. PDT should be used as an adjunct to biliary stenting in these patients.展开更多
AIM To evaluate the effect of silymarin on the serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST) and gamma glutamyl transpeptidase(γGT) in patients with liver diseases. METHODS A systemati...AIM To evaluate the effect of silymarin on the serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST) and gamma glutamyl transpeptidase(γGT) in patients with liver diseases. METHODS A systematic review with meta-analysis of ramdomized and controlled clinical trials was performed,evaluating the effects of sylimarin in patients with hepatic diseases,published by January 31,2016. Clinical trials were sought on the basis of The Cochrane Central Register of Controlled Trials in the Cochrane Library,Pub Med/Medline,Scopus,Web of Science,Lilacs and Clinical Trials. The trials with adult and elderly patients of both sexes,with Liver Diseases who took oral silymarin supplementation,as extract or isolated,as well as Silymarin combined with other nutrients,were included. The trials should provide information about the intervention,such as dosages and detailing of the product used,besides the mean and standard deviation of serum levels of ALT,AST and γGT of the baseline and at the end of the intervention.RESULTS An amount of 10904 publications were identified. From those,only 17 were included in the systematic review and 6 in the meta-analysis,according to the used selection criteria. In this meta-analysis,the results indicated a reduction of 0.26 IU/m L(95%CI:-0.46-0.07,P = 0.007) at the level of ALT and 0.53 IU/m L(95%CI:-0.74-0.32,P = 0.000) at the serum levels of AST after using the silymarin,both,statistically significant,but with no clinical relevance. There was no significant change in the γGT levels. Subgroup analyzes were also performed for the biochemical markers in relation to the type of intervention,whether silymarin isolated or associated with other nutrients and the time of intervention(whether ≥ 6 mo or < 6 mo). Significant differences were not found. The evaluated studies presented a high degree of heterogeneity and low methodological quality in the carried out analysis. CONCLUSION Silymarin minimally reduced,but without clinical relevance,the serum levels of ALT and AST. It is necessary to carry out studies with more appropriate methodological designs.展开更多
AIM To evaluate the therapeutic role of double-balloon enteroscopy(DBE) in small bowel strictures and to propose a standard approach to small bowel strictures.METHODS Systematic review of studies involving DBE in pati...AIM To evaluate the therapeutic role of double-balloon enteroscopy(DBE) in small bowel strictures and to propose a standard approach to small bowel strictures.METHODS Systematic review of studies involving DBE in patients with small bowel strictures. Only studies limited to small bowel strictures were included and those with ileo-colonic strictures were excluded. RESULTS In total 13 studies were included,in which 310 patients were dilated. The average follow-up time was 31.8 mo per patient. The complication rate was 4.8% per patient and 2.6% per dilatation. Surgery was avoided in 80% of patients. After the first dilatation,46% were treated with re-dilatation and only 17% required surgery.CONCLUSION DBE-assisted dilatation avoids surgery in 80% of patients with small bowel strictures and is safe and effective. We propose a standardized approach to small bowel strictures.展开更多
基金Supported by National Natural Science Foundation of China,No.81372243,No.81570593 and No.81370575Key Scientific and Technological Projects of Guangdong Province,No.2014B020228003 and No.2014B030301041+2 种基金Natural Science Foundation of Guangdong Province,No.2015A030312013Science and Technology Planning Project of Guangzhou,No.201400000001-3,No.201508020262 and No.2014J4100128Science and Technology Planning Project of Guangdong Province,No.2017A020215178
文摘AIM To perform a meta-analysis on laparoscopic hepatectomy VS conventional liver resection for treating hepatolithiasis.METHODS We conducted a systematic literature search on Pub Med,Embase,Web of Science and Cochrane Library,and undertook a meta-analysis to compare the efficacy and safety of laparoscopic hepatectomy V S conventional open liver resection for local hepatolithiasis in the left or right lobe. Intraoperative and postoperative outcomes(time,estimated blood loss,blood transfusion rate,postoperative intestinal function recovery time,length of hospital stay,postoperative complication rate,initial residual stone,final residual stone and stone recurrence) were analyzed systematically.RESULTS A comprehensive literature search retrieved 16 publications with a total of 1329 cases. Meta-analysis of these studies showed that the laparoscopic approach for hepatolithiasis was associated with significantly less intraoperative estimated blood loss [weighted mean difference(WMD): 61.56,95% confidence interval(CI): 14.91-108.20,P = 0.01],lower blood transfusion rate [odds ratio(OR): 0.41,95%CI: 0.22-0.79,P = 0.008],shorter intestinal function recovery time(WMD: 0.98,95%CI: 0.47-1.48,P = 0.01),lower total postoperative complication rate(OR: 0.52,95%CI: 0.39-0.70,P < 0.0001) and shorter stay in hospital(WMD: 3.32,95%CI: 2.32-4.32,P < 0.00001). In addition,our results showed no significant differences between the two groups in operative time(WMD: 21.49,95%CI: 0.27-43.24,P = 0.05),residual stones(OR: 0.79,95%CI: 0.50-1.25,P = 0.31) and stone recurrence(OR: 0.34,95%CI: 0.11-1.08,P = 0.07). Furthermore,with subgroups analysis,our results proved that the laparoscopic approach for hepatolithiasis in the left lateral lobe and left side could achieve satisfactory therapeutic effects. CONCLUSION The laparoscopic approach is safe and effective,with less intraoperative estimated blood loss,fewer postoperative complications,reduced length of hospital stay and shorter intestinal function recovery time than with conventional approaches.
文摘AIM To perform a systematic review and meta-analysis on clinical outcomes of photodynamic therapy(PDT) in non-resectable cholangiocarcinoma. METHODS Included studies compared outcomes with photodynamic therapy and biliary stenting(PDT group) vs biliary stenting only(BS group) in palliation of non-resectable cholangiocarcinoma. Articles were searched in MEDLINE, PubM ed, and EMBASE. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using the I2 statistic.RESULTS Ten studies(n = 402) that met inclusion criteria were included in this analysis. The P for χ2 heterogeneity for all the pooled accuracy estimates was > 0.10. Pooled odds ratio for successful biliary drainage(decrease in bilirubin level > 50% within 7days after stenting)in PDT vs BS group was 4.39(95%CI: 2.35-8.19).Survival period in PDT and BS groups were 413.04d(95%CI: 349.54-476.54) and 183.41(95%CI:136.81-230.02) respectively. The change in Karnofsky performance scores after intervention in PDT and BS groups were +6.99(95%CI: 4.15-9.82) and-3.93(95%CI:-8.63-0.77) respectively. Odds ratio for postintervention cholangitis in PDT vs BS group was 0.57(95%CI: 0.35-0.94). In PDT group, 10.51%(95%CI:6.94-14.72) had photosensitivity reactions that were self-limiting. Subgroup analysis of prospective studies showed similar results, except the incidence of cholangitis was comparable in both groups. CONCLUSION In palliation of unresectable cholangiocarcinoma, PDT seems to be significantly superior to BS alone. PDT should be used as an adjunct to biliary stenting in these patients.
文摘AIM To evaluate the effect of silymarin on the serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST) and gamma glutamyl transpeptidase(γGT) in patients with liver diseases. METHODS A systematic review with meta-analysis of ramdomized and controlled clinical trials was performed,evaluating the effects of sylimarin in patients with hepatic diseases,published by January 31,2016. Clinical trials were sought on the basis of The Cochrane Central Register of Controlled Trials in the Cochrane Library,Pub Med/Medline,Scopus,Web of Science,Lilacs and Clinical Trials. The trials with adult and elderly patients of both sexes,with Liver Diseases who took oral silymarin supplementation,as extract or isolated,as well as Silymarin combined with other nutrients,were included. The trials should provide information about the intervention,such as dosages and detailing of the product used,besides the mean and standard deviation of serum levels of ALT,AST and γGT of the baseline and at the end of the intervention.RESULTS An amount of 10904 publications were identified. From those,only 17 were included in the systematic review and 6 in the meta-analysis,according to the used selection criteria. In this meta-analysis,the results indicated a reduction of 0.26 IU/m L(95%CI:-0.46-0.07,P = 0.007) at the level of ALT and 0.53 IU/m L(95%CI:-0.74-0.32,P = 0.000) at the serum levels of AST after using the silymarin,both,statistically significant,but with no clinical relevance. There was no significant change in the γGT levels. Subgroup analyzes were also performed for the biochemical markers in relation to the type of intervention,whether silymarin isolated or associated with other nutrients and the time of intervention(whether ≥ 6 mo or < 6 mo). Significant differences were not found. The evaluated studies presented a high degree of heterogeneity and low methodological quality in the carried out analysis. CONCLUSION Silymarin minimally reduced,but without clinical relevance,the serum levels of ALT and AST. It is necessary to carry out studies with more appropriate methodological designs.
文摘AIM To evaluate the therapeutic role of double-balloon enteroscopy(DBE) in small bowel strictures and to propose a standard approach to small bowel strictures.METHODS Systematic review of studies involving DBE in patients with small bowel strictures. Only studies limited to small bowel strictures were included and those with ileo-colonic strictures were excluded. RESULTS In total 13 studies were included,in which 310 patients were dilated. The average follow-up time was 31.8 mo per patient. The complication rate was 4.8% per patient and 2.6% per dilatation. Surgery was avoided in 80% of patients. After the first dilatation,46% were treated with re-dilatation and only 17% required surgery.CONCLUSION DBE-assisted dilatation avoids surgery in 80% of patients with small bowel strictures and is safe and effective. We propose a standardized approach to small bowel strictures.
