内镜保胆取石术与腹腔镜胆囊切除术治疗胆囊结石围手术期安全性的Meta分析

Meta-analysis of the perioperative safety of endoscopic gallbladder-preserving cholecystolithotomy and laparoscopic cholecystectomy for cholecystolithiasis

摘要:

目的 系统评价内镜保胆取石术（EGPC）和腹腔镜胆囊切除术（LC）治疗胆囊结石的有效性及安全性。方法 计算机检索中国知网、万方数据、维普、PubMed、Embase、Web of Science和The Cochrane Library等，收集2000年1月－2022年6月关于EGPC和LC治疗胆囊结石的随机对照试验（RCT），检索语言仅限于中文和英文。对获得的文献进行筛选、数据提取和质量评价，运用RevMan 5.4软件进行统计学分析。结果 22篇中文文献被纳入研究，共1 888例患者。与LC组比较，EGPC组术中出血量更少（MD = -12.88，95%CI：-16.29～-9.47，P = 0.000），术后肛门排气时间更短（MD = -6.05，95%CI：-8.17～-3.93，P = 0.000），术后下床活动时间更短（MD = -4.76，95%CI：-5.89～-3.62，P = 0.000），术后并发症发生率更低（OR＾ = 0.25，95%CI：0.17～0.36，P = 0.000），两组患者手术时间（MD = 1.79，95%CI：-5.02～8.59，P = 0.610）和住院时间（MD = -0.68，95%CI：-1.48～0.12，P = 0.100）比较，差异无统计学意义。结论 EGPC对于满足保胆取石指征的患者，具有一定的临床运用价值，但由于研究纳入文献质量较低，结论还不足以支持EGPC在治疗胆囊结石方面优于LC，有待下一步纳入高质量的RCT进行验证。

Abstract:

Objective To systematically review the efficacy and safety of endoscopic gallbladder-preserving cholecystolithotomy (EGPC) and laparoscopic cholecystectomy (LC) in treatment of simple cholecystolithiasis.Methods The databases of CNKI, Wanfang, VIP, PubMed, Embase, Web of Science and The Cochrane Library database from January 2000 to June 2022 were searched by computer. Randomized controlled trials (RCT) of EGPC and LC for the treatment of gallstones were collected. The search language was limited to Chinese and English. After screening, data extraction and quality evaluation of the obtained literature, RevMan 5.4 software was used for statistical analysis.Results Twenty-two Chinese literatures were included in this study, with a total of 1 888 cases. Compared with the LC group, the EGPC group had less intraoperative bleeding (MD = -12.88, 95%CI: -16.29~-9.47, P = 0.000) and earlier postoperative anal exhaust time (MD = -6.05. 95%CI: -8.17 ~ -3.93, P = 0.000), earlier time to get out of bed after operation (MD = -4.76, 95%CI: -5.89 ~ -3.62, P = 0.000), and lower incidence of postoperative complications (OR＾ = 0.25, 95%CI: 0.17 ~ 0.36, P = 0.000). There were not significantly different in the operation time (MD = 1.79, 95%CI: -5.02 ~ 8.59, P = 0.610), and hospital stay (MD = -0.68, 95%CI: -1.48 ~ 0.12, P = 0.100).Conclusion EGPC has a certain clinical value for patients who meet the indications for gallstone preservation. However, due to the low quality of the included literatures, our conclusion is not enough to support EGPC in the treatment of simple cholecystolithiasis than LC, and high quality is needed in the future. The RCT study is further validated.