急性胆囊炎行腹腔镜胆囊切除术手术时机选择的Meta分析

目的:系统评价腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗急性胆囊炎的最佳手术时机。方法:通过计算机检索万方、中文科技期刊、中国知网等数据库,查找所有比较早期与延期行LC治疗急性胆囊炎疗效的随机对照试验中文文献,检索时限为建库至2016年8月,按照纳入、排除标准由两名独立的研究人员进行文献选择、数据提取及质量评价,使用Rev Man 5.3软件进行Meta分析。结果:共纳入15项研究,总计2 325例患者。本研究所收集的数据经Meta分析提示,与延期LC相比,早期LC具有更低的中转开腹率[OR=0.55,95%CI(0.37,0.83),P=0.004]、更低的并发症发生率[OR=0.64,95%CI(0.45,0.91),P=0.01]、更短的手术时间[MD=-3.69,95%CI(-5.46,-1.92),P<0.0001],差异有统计学意义。结论:相较延期LC,急性胆囊炎发作72 h内早期行LC可降低中转开腹率、并发症发生率,缩短手术时间,可能是治疗急性胆囊炎的最佳手术时机。

A meta analysis on timing of laparoscopic cholecystectomy for acute cholecystitis

Objective:To systematically evaluate the most suitable timing of laparoscopic cholecystectomy for acute cholecystitis.Methods:The Chinese data of randomized controlled trials to compare early and delayed laparoscopic cholecystectomy for acute cholecystitis were searched in WANFANG,CNKI and Chinese Technology Periodical Database from establishment to Aug.2016.Data were selected,extracted and evaluated by two independent researchers according to inclusion and exclusion criteria.Meta-analyses were conducted using the RevMan 5.3 software.Results:Fifteen controlled clinical trials (n=2 325) were included.After meta-analysis,the data collected in this study suggested that compared with delayed laparoscopic cholecystectomy,early laparoscopic cholecystectomy was associated with a lower rate of conversion to laparotomy [OR=0.55,95% CI(0.37,0.83),P=0.004],a lower rate of complications [OR=0.64,95% CI(0.45,0.91),P=0.01] and shorter operation time [MD=-3.69,95% CI(-5.46,-1.92),P<0.0001],the differences were statistically significant.Conclusions:Compared with delayed laparoscopic cholecystectomy,early laparoscopic cholecystectomy within 72 h can reduce the rate of conversion to laparotomy,the rate of complications and operation time,and may be the most suitable timing of laparoscopic cholecystectomy for acute cholecystitis.