临床研究(Clinical Research)

早期不同时间点行腹腔镜胆囊切除术治疗急性结石性胆囊炎疗效及安全性的Meta分析

Published at: 2017年第26卷第8期

孙明明 1 , 范逸怡 1 , 党胜春 1
1 江苏大学附属医院 普通外科,江苏 镇江 212001
通讯作者 胜春 党 Email: dscgu@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.08.010
基金:
胆囊炎,急性;胆囊结石病;胆囊切除术,腹腔镜;Meta分析 2016-WSN-007

摘要

目的:比较早期不同时间点行腹腔镜胆囊切除术(LC)治疗急性结石性胆囊炎(ACC)的疗效及安全性。方法:检索2017年4月以前国内外数据库公开发表的比较不同时机LC治疗ACC疗效及安全性的临床研究。采用RevMan 5.3软件对相关临床指标进行Meta分析。结果: 共纳入15篇文献,共16 389例患者,其中13 417例发病48 h内行LC,2 972例发病48~72 h内行LC。Meta分析结果显示,48 h内行LC者较48~72 h内行LC者手术时间缩短(MD=-11.33,95% CI= -17.26~-5.40,P=0.0002)、术中出血量减少(MD=-24.60,95% CI=-45.83~-3.36,P=0.02)、胆管损伤发生率降低(OR=0.48,95% CI=0.26~0.90,P=0.02)、中转开腹率降低(OR=0.56,95% CI= 0.43~0.74,P<0.0001);而两组患者的住院时间、总并发症发生率、胆汁漏发生率、肠梗阻发生率、术后腹腔内出血发生率、切口感染发生率、腹腔感染发生率、肺部感染发生率以及切口疝发生率的差异均无统计学意义(均P>0.05)。结论:ACC患者在发病48 h内行LC具有较好的疗效及安全性。


Efficacy and safety of laparoscopic cholecystectomy in treatment of acute calculous cholecystitis at different timing within early stage: a Meta-analysis

Abstract

Objective: To compare the efficacy and safety of laparoscopic cholecystectomy (LC) in treatment of acute calculous cholecystitis (ACC) at different timing within early stage. Methods: The literature of clinical studies comparing the efficacy and safety of LC at different timings for ACC publically published before April 2017 was searched from national and international databases. Meta-analysis was performed on some relevant clinical variables by using RevMan 5.3 software. Results: Fifteen studies were included, involving 16 389 patients, of whom, 13 417 cases underwent LC within 48 h after onset and 2 972 cases underwent LC within 48 to 72 h after onset. The results of Meta-analysis showed that, the operative time (MD=–11.33, 95% CI=–17.26––5.40, P=0.0002), intraoperative blood loss (MD=–24.60, 95% CI=–45.83––3.36, P=0.02), incidence of bile duct injury (OR=0.48, 95% CI=0.26 0.90, P=0.02) and open conversion rate (OR=0.56, 95% CI=0.43–0.74, P<0.0001) were reduced in patients undergoing LC within 48 h compared with those undergoing LC within 48 to 72 h. The differences in the length of hospital stay, overall incidence of complications and the incidence of bile leakage, intestinal obstruction, postoperative intra-abdominal hemorrhage, wound infection, abdominal infection, pulmonary infection and incisional hernia showed no statistical significance between the two groups of patients (all P>0.05). Conclusion: In ACC patients, LC has better efficacy and safety when performing within 48 h after onset.


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引用

引用本文: 明明 孙, 逸怡 范, 胜春 党. 早期不同时间点行腹腔镜胆囊切除术治疗急性结石性胆囊炎疗效及安全性的Meta分析 [J]. 中国普通外科杂志, 2017, 26(8): 1019-1029.
Cite this article as: SUN Mingming, FAN Yiyi, DANG Shengchun . Efficacy and safety of laparoscopic cholecystectomy in treatment of acute calculous cholecystitis at different timing within early stage: a Meta-analysis [J]. Chin J Gen Surg, 2017, 26(8): 1019-1029.