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中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (05) : 499 -503. doi: 10.3877/cma.j.issn.1674-3946.2020.05.020

所属专题： 文献；

论著

基于META分析的内镜微创保胆取石术与腹腔镜胆囊切除术治疗胆囊结石方法研究
钟锴1, 穆热艾合买提江·穆塔里夫1, 鲁发顺1, 郑晓洁2, 蒋铁民1, 冉博1, 郭强1, 张瑞青1, 吐尔干艾力·阿吉1, 邵英梅1,†()   
  1. 1. 830054　乌鲁木齐，新疆医科大学第一附属医院消化血管外科中心肝胆包虫外科；830054　乌鲁木齐，新疆医科大学第一附属医院新疆维吾尔自治区包虫及肝胆疾病临床医学研究中心
    2. 830054　乌鲁木齐，新疆医科大学第一附属医院教学科研部学科建设科
  • 收稿日期:2020-02-07 出版日期:2020-10-26
  • 通信作者: 邵英梅

Endoscopic minimal invasive cholecystolithotomy and laparoscopic cholecystectomy for cholecystolithiasis: a meta-analysis

Kai Zhong1, Mutalifu Mureaihemaitijiang·1, Fashun Lu1, Xiaojie Zhen2, Tiemin Jiang1, Bo Ran1, Qiang Guo1, Ruiqing Zhang1, Aji Tuerganaili·1, Yingmei Shao1,†()   

  1. 1. Department of Hepatobiliary & Hydatid Diseases, Digestive & Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China; Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
    2. Subject Construction Section of the Department of Teaching and Research; The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
  • Received:2020-02-07 Published:2020-10-26
  • Corresponding author: Yingmei Shao
  • About author:
    Corresponding author: Shao Yingmei, Email:
  • Supported by:
    Key discipline of the 13th five-year plan of autonomous region (Peak discipline)(New Teaching Research (2016) No.7); Natural Science Foundation of Xinjiang Uygur Autonomous Region(2018D01C220); National Natural Science Foundation of China(81660108); National Key R&D Program of China(2017YFC0909903); Key Laboratory of Basic Medicine for hydatidosis in Xinjiang Uygur Autonomous Region(2017D04004)
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钟锴, 穆热艾合买提江·穆塔里夫, 鲁发顺, 郑晓洁, 蒋铁民, 冉博, 郭强, 张瑞青, 吐尔干艾力·阿吉, 邵英梅. 基于META分析的内镜微创保胆取石术与腹腔镜胆囊切除术治疗胆囊结石方法研究[J]. 中华普外科手术学杂志(电子版), 2020, 14(05): 499-503.

Kai Zhong, Mutalifu Mureaihemaitijiang·, Fashun Lu, Xiaojie Zhen, Tiemin Jiang, Bo Ran, Qiang Guo, Ruiqing Zhang, Aji Tuerganaili·, Yingmei Shao. Endoscopic minimal invasive cholecystolithotomy and laparoscopic cholecystectomy for cholecystolithiasis: a meta-analysis[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(05): 499-503.

目的

通过META分析的方式评价经内镜微创保胆取石术(EMIC)和腹腔镜胆囊切除术(LC)在治疗胆囊结石中的临床疗效。

方法

查找2015年至2020年在中国知网、维普、万方、PubMed等数据库中关于经EMIC和LC在治疗胆囊结石的试验及分析文献进行对比研究，共纳入9篇文献(1113例患者)。利用STATA15的方法进行META分析，通过标准化均数差(SMD)、比值比(OR)、95%置信区间(CI)对比分析EMIC和LC的有效性及安全性。

结果

META分析结果显示：EMIC组与LC组在手术时间[SMD＝0.471(-0.154, 1.097)]、住院时间[SMD＝-0.341(-0.688, 0.007)]、术后并发症发生率[OR＝0.531(0.247, 1.138)]方面两组差异无统计学意义(P>0.05)；但在术中出血量[SMD＝-1.255(-2.152, -0.358)]、术后胃肠道通气时间[SMD＝-1.778(-3.059, -0.497)]方面EMIC组低于LC组(P<0.05)，但EMIC组住院费用高于LC组[SMD＝0.232(0.043, 0.422)]，(P<0.05);在术后结石复发率[OR＝3.513(1.031, 11.964)]方面，LC组低于EMIC组(P<0.05)。

结论

EMIC相较LC在治疗胆囊结石中有其特有的优势，主要体现为术中出血少、患者胃肠道功能恢复快。但EMIC组住院花费、结石复发率高于LC组，临床上选择何种手术方式治疗胆结石，需经过更详细、慎重的思考，严格把控手术指征。

关键词: 胆囊切除术，腹腔镜, Meta分析, 经内镜微创保胆取石术, 疗效比较研究
Objective

Using meta-analysis to evaluate the clinical efficacy of Endoscopic Minimal Invasive Cholecystolithotomy (EMIC) and Laparoscopic Cholecystectomy (LC) in the treatment of gallstones.

Methods

A comparative study of EMIC and LC for the treatment of gallstones in the Chinese biomedical literature database, China knowledge network, Vip, WanFang database, and PubMed , database from 2015 to 2020, a total of 9 literatures were included (1113 patients). Meta analysis was performed with stata15. The effectiveness and safety of the two methods were compared with 95% confidence interval (CI), calculated odds ratio (OR).

Results

The results of meta-analysis showed that there was no significant difference in the time of operation [SMD=0.471(-0.154, 1.097)], the time of hospitalization [SMD=-0.341(-0.688, 0.007)], the incidence of postoperative complications [OR=0.531(0.247, 1.138)](P>0.05). However, the difference in the amount of intraoperative bleeding [SMD=-1.255(-2.152, -0.358)] and the time of postoperative gastrointestinal ventilation [SMD=-1.778(-3.059, -0.497)] was statistically significant(P<0.05), the cost of hospitalization in the EMIC group was higher than that in the LC group [SMD=0.232(0.043, 0.422)](P<0.05). The LC group was lower than the EMIC group in terms of the recurrence rate of postoperative stones [OR=3.513(1.031, 11.964)](P<0.05).

Conclusions

Compared with LC, the EMIC in the treatment of gallstone has its unique advantages, mainly characterized by less intraoperative bleeding, patients with rapid recovery of gastrointestinal function. The cost of hospitalization and the recurrence rate of stones in EMIC group were higher than that in LC group. It is necessary to strictly control the surgical indications through more detailed and careful thinking about what kind of operation method to treat gallstones in clinic.

Key words: Cholecystectomy, laparoscopic, Meta-analysis, Endoscopic minimal invasive cholecystolithotomy, Comparative effectiveness research
表1 纳入研究的EMIC和LC在治疗胆囊结石9篇文献的一般基线资料
作者 年份 例数 性别 年龄
EMIC组 LC组 男/女 EMIC组 LC组
Zhang Yang 2016 84 93 106/145 34.1±15.1 51.2±13.8
甄永强 2018 48 48 53/54 48.4±10.7 47.9±9.8
马吉安 2017 72 98 65/105 51.9±14.9 48.7±11.8
梁钰安 2016 75 75 84/66 56.2±20.0 58.3±18.1
王彬 2015 36 58 41/53 55.9±12.8 57.6±13.8
王汉长 2018 68 68 93/43 36.8±6.9 36.7±6.9
陈亮 2019 60 60 67/53 24～77岁 22～77岁
朱任飞 2016 34 34 22/46 19～68岁 28～67岁
陈涛 2018 40 62 64/38 65.6±6.2 67.4±5.8
图1 9篇治疗胆囊结石文献的术中出血量对比分析图
图2 9篇治疗胆囊结石文献的术后通气时间对比分析图
图3 9篇治疗胆囊结石文献的住院费用对比分析图
图4 9篇治疗胆囊结石文献的术后结石复发率对比分析图
图5 9篇治疗胆囊结石文献的术后结石复发率对比分析图
图6 9篇治疗胆囊结石文献的术后结石复发率漏斗图
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