摘要
目的通过Meta分析系统评价腹腔镜下胆道镜联合钬激光碎石术的有效性及安全性。方法本研究根据PRISMA指南完成,PROSPERO注册号:CRD42023406221。计算机检索中国知网、万方、维普等中文数据库以及PubMed、Embase、Cochrane Library、Web of Science等外文数据库中比较传统开腹手术与腹腔镜联合胆道镜钬激光治疗胆管结石的原始文献,通过优势比(OR)和95%可信区间(95%CI)评估二分类变量,通过加权平均差(WMD)和95%CI评估连续性变量,并对异质性较高结局指标进行敏感性分析。Begg检验和Egger检验用于评估发表偏倚。应用Stata 15.0软件和Review Manager 5.3软件进行统计分析。结果纳入来自中国的29项回顾性研究,共2511例患者。Meta分析结果显示,与传统开腹手术相比,腹腔镜联合胆道镜钬激光治疗胆管结石的手术时间(WMD=-1.26,95%CI:-1.36~-1.16,P<0.001)、住院时间(WMD=-1.93,95%CI:-2.64~-1.12,P<0.001)及肠道功能恢复时间(WMD=-1.52,95%CI:-1.68~-1.35,P<0.001)更短,术中出血量更少(WMD=-1.79,95%CI:-1.93~-1.66,P<0.001),术中残石率更低(OR=0.15,95%CI:0.11~0.20,P<0.001),并发症更少(OR=0.17,95%CI:0.13~0.23,P<0.001)。结论相比于传统开腹手术治疗胆管结石,腹腔镜联合胆道镜钬激光治疗胆管结石显示出更好的有效性。
Objective To systematically review the efficacy and safety of laparoscopic choledochoscopy combined with holmium laser lithotripsy through a meta-analysis.Methods This study was conducted based on PRISMA guidelines,with a PROSPERO registration number of CRD42023406221.Chinese databases including CNKI,Wanfang Data,and VIP and foreign language databases such as PubMed,Embase,the Cochrane Library,and Web of Science were searched for original articles on traditional laparotomy versus laparoscopic choledochoscopy combined with holmium laser lithotripsy in the treatment of bile duct stones.Dichotomous variables were assessed by odds ratio(OR)and 95%confidence interval(CI),while continuous variables were assessed by weighted mean difference(WMD)and 95%CI,and a sensitivity analysis was performed for outcome measures with relatively high heterogeneity.The Begg test and Egger test were used to evaluate publication bias.Stata 15.0 and Review Manager 5.3 were used to perform the statistical analysis.Results A total of 26 retrospective studies from China were included in this study,with 2238 patients in total.The meta-analysis showed that compared with traditional laparotomy for the treatment of bile duct stones,laparoscopic choledochoscopy combined with holmium laser lithotripsy had significantly shorter time of operation(WMD=-1.26,95%CI:-1.36 to-1.16,P<0.001),length of hospital stay(WMD=-1.93,95%CI:-2.64 to-1.12,P<0.001),and time to bowel function recovery(WMD=-1.52,95%CI:-1.68 to-1.35,P<0.001),significantly less intraoperative blood loss(WMD=-1.79,95%CI:-1.93 to-1.66,P<0.001),a significantly lower rate of intraoperative residual stone(OR=0.15,95%CI:0.11-0.20,P<0.001),and significantly fewer complications(OR=0.17,95%CI:0.13-0.23,P<0.001).Conclusion Compared with traditional laparotomy,laparoscopic choledochoscopy combined with holmium laser lithotripsy shows better efficacy in the treatment of bile duct stones.
作者
牛向东
余静
汪旭云
陈一锋
马世勋
丁国淦
苗长丰
王晓鹏
苏河
NIU Xiangdong;YU Jing;WANG Xuyun;CHEN Yifeng;MA Shixun;DING Guogan;MIAO Changfeng;WANG Xiaopeng;SU He(Department of General Surgery,Gansu Provincial Hospital,Lanzhou 730030,China;Department of Geriatric Medicine,Gansu Provincial Hospital,Lanzhou 730030,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2023年第10期2421-2431,共11页
Journal of Clinical Hepatology
基金
甘肃省人民医院重点研发项目(17GSSY3-2)
甘肃省人民医院院内青年项目(21GSSYC-17)
甘肃省自然科学基金(20JR10RA381)。
