急性胆囊炎早期与晚期腹腔镜下胆囊切除术安全性及临床结局对比的荟萃分析

发布时间：2018-12-12 03:43

【摘要】：[目的]一直以来,急性胆囊炎的外科治疗方式一直是急诊外科界聚焦的热点之一。自Erich Miihe医生1985年完成第一例腹腔镜下胆囊切除术(LaparoscopicCholecystectomy,LC)以来,该术式正逐渐取代传统的开腹手术及其他治疗方法成为一线的治疗手段。尽管如此,对于何时进行手术最为合适仍然存在着较大的争议。本文将研究急性胆囊炎患者接受早期或晚期腹腔镜下胆囊切除术的临床随机对照研究,并对结果进行荟萃分析,旨在研究不同时间进行腹腔镜下胆囊切除术的安全性及相应的临床结局。[方法]通过查阅检索电子文献的方式,检索关于急性胆囊炎患者行早期或晚期腹腔镜下胆囊切除术的随机对照研究(Randomized Controlled trials, RCT)。检索数据库包括TThe Cochrane Library trials register, MEDLINE (PubMed), EMBASE (Ovid). Science Citation Index Expanded (Web of Knowledge)。必要时与通讯作者联系获得相关文献及数据。通过检索,由两位评价者独立评价所获得的文献,纳入了2013年12月31日之前所有涉及急性胆囊炎患者行早期腹腔镜下胆囊切除术与晚期腹腔镜下胆囊切除术对比的随机对照研究。此次研究统计分析了以上两组患者手术安全性(如死亡率、术后并发症等)以及治疗结局(住院天数、手术时间、生活质量),并采用Review Manager 5.2软件进行荟萃分析(meta-analysis)。[结果]通过检索和评价,共有7项研究纳入本次荟萃分析。在这7项研究中,1106名适合进行腹腔镜下胆囊切除术的急性胆囊炎患者被随机分为两组,其中一组行早期腹腔镜下胆囊切除术(548人),另一组行晚期腹腔镜下胆囊切除术(558人)。早期手术组患者发生胆总管损伤率和中转开腹手术率相对晚期手术组有所减少,但都未见显著性差异(胆总管损伤率的Peto法比值比(odds radio, OR):0.49(95% CI 0.05-4.72), P=0.54);转开腹手术率的相对危险度(relative risk,RR)：0.91(95% CI0.69-1.20)；P=0.50)。早期手术组的总住院天数明显少于晚期手术组(早期手术组平均住院时间少4.12天,P0.00001)。[结论]通过本次荟萃分析可以看到,相较于晚期行手术的急性胆囊炎患者,早期行腹腔镜下胆囊切除术不仅没有增加手术并发症和中转开腹手术的风险,而且显著缩短了住院所需时间。
[Abstract]:Objective: surgical treatment of acute cholecystitis has been one of the focuses in emergency surgery. Since Dr. Erich Miihe completed the first laparoscopic cholecystectomy (LaparoscopicCholecystectomy,LC) in 1985, this procedure is gradually replacing the traditional open surgery and other treatment methods as the first-line treatment. However, there is still considerable debate about when the operation is most appropriate. We will study the clinical randomized controlled study of early or late laparoscopic cholecystectomy in patients with acute cholecystitis and make a meta-analysis of the results. To study the safety and clinical outcome of laparoscopic cholecystectomy at different times. [methods] A randomized controlled study of early or late laparoscopic cholecystectomy in patients with acute cholecystitis was retrieved by consulting electronic literature. (Randomized Controlled trials, RCT). Retrieving databases including TThe Cochrane Library trials register, MEDLINE (PubMed), EMBASE (Ovid). Science Citation Index Expanded (Web of Knowledge). Contact the author to obtain relevant documents and data if necessary. Through retrieval, two reviewers independently evaluate the literature obtained, A randomized controlled study was included to compare early laparoscopic cholecystectomy with late laparoscopic cholecystectomy in all patients with acute cholecystitis by December 31, 2013. The study statistically analyzed the surgical safety (such as mortality, postoperative complications, etc.) and the outcome (length of stay, operating time, quality of life) of the two groups. The meta-analysis (meta-analysis) was carried out with Review Manager 5.2 software. Results A total of 7 studies were included in this meta-analysis through retrieval and evaluation. Of the seven studies, 1106 patients with acute cholecystitis who were eligible for laparoscopic cholecystectomy were randomized into two groups: one group underwent early laparoscopic cholecystectomy (548 patients). The other group underwent advanced laparoscopic cholecystectomy (558 patients). The incidence of common bile duct injury and the rate of conversion to open surgery in the early operation group were lower than those in the late operation group, but there was no significant difference (the ratio of Peto to (odds radio, was higher than that of (odds radio,). OR): 0.49 (95% CI 0.05-4.72); The relative risk of conversion to open surgery (relative risk,RR): 0.91 (95% CI0.69-1.20); P0. 50) The total length of hospitalization in the early operation group was significantly less than that in the late operation group (4.12 days less, P 0.00001). [conclusion] from this meta-analysis, we can see that the early laparoscopic cholecystectomy not only does not increase the risk of surgical complications and conversion to open surgery, but also shows that the patients with acute cholecystitis undergoing late operation have no increased risk of early laparoscopic cholecystectomy. And significantly shortened the length of stay in hospital.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R657.4

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