摘要
目的 比较术前内镜下括约肌切开术（POES）与术中内镜下括约肌切开术（IOES）治疗胆囊结石合并胆总管结石的安全性和有效性.方法 我们检索了多个电子数据库关于POES与IOES的前瞻性随机对照研究.我们对以下结果进行分析：结石清除率,术后并发症及住院时间.结果 5个试验共631例患者（318例POES患者和313例[OES患者）符合标准.胆总管结石总的清除率两者相似,但IOES组内镜逆行胰胆管造影（ERCP）插管失败率更高.总体并发症发生率两者相似,但POES患者ERCP相关并发症发生率较高.腹腔镜胆囊切除术相关的并发症发病率及中转进腹手术的比例两者差异无统计学意义.亚组分析显示,出血、穿孔、胆管炎、胆囊炎和胃溃疡的发生率在两者之间差异无统计学意义.结论 对于胆囊结石合并胆总管结石患者,POES与[OES在结石清除率和总并发症发生率方面没有差异.然而,IOES组ERCP相关性胰腺炎的发生率较低,住院时间较短。
Objective To compare the safety and efficiency of preoperative endoscopic sphincterotomy （POES） versus intraoperative endoscopic sphincterotomy （IOES） in patients with gallbladder and common bile duct stones.Methods Multiple electronic databases were searched for prospective,randomized,controlled trials on the safety and effectiveness of POES versus IOES.And the outcome parameters of clearance rate,post-procedural complications and hospital stay were analyzed.Results Five trials with 631 patients （POES,n =318;IOES,n =313） were analyzed.Although the overall rates of common bile duct stone clearance were similar between POES and IOES （RR 0.96,95% CI：0.91-1.01;P =0.13）,the failure rate of CBD cannulation was significantly higher for IOES （RR 2.54,95% CI：1.23-5.26;P =0.01） during endoscopic retrograde cholangiopancreatography （ERCP）.The pooled RR after POES for overall complication rates was similar to that for IOES （RR 1.56,95% CI：0.94-2.59;P =0.09）.However,as compared with IOES,the RR risk of ERCP-related complications was significantly higher for POES （RR 2.27,95% CI：1.18-4.40,P =0.0l）.No significant inter-group differences existed in morbidity after laparoscopic cholecystectomy or subsequent conversion into open surgery.In subgroup analyses,the rates of hemorrhage,perforation,cholangitis,cholecystitis,and gastric ulceration showed no significant inter-group differences.Conclusion With regards to stone clearance and overall complication rate,POES is comparable to IOES in patients with gallbladder and common bile duct stones.However,IOES has a lowered incidence of ERCP-related pancreatitis and a shorter hospital stay.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第18期1425-1429,共5页
National Medical Journal of China
