ERCP术后胆总管结石复发危险因素的Meta分析

目的 采用荟萃分析的方法系统评价内镜逆行胰胆管造影术(ERCP)后胆总管结石复发的危险因素,为预防其复发提供参考依据.方法 计算机检索PubMed、Cochrane Library、EMbase、CBMdisc、CNKI、WANGFANG等数据库,采用Cochrane协作网推荐的RevMan 5.3软件进行Meta分析.结果 最终共纳入18篇回顾性病例对照研究,共计患者10797例.Meta分析结果示,合并乳头旁憩室(OR=2.43,95%CI:1.84~3.21)、术前多发结石(OR=1.63,95%CI:1.20~2.20)、术前结石直径>1 cm(OR=2.53,95%CI:1.73~3.70)、胆总管直径>15 mm(OR=2.39,95%CI:1.84~3.11)、合并胆囊结石(OR=1.20,95%CI:0.82~1.76)、胆道狭窄(OR=2.70,95%CI:1.66~4.41)、机械碎石术(OR=2.15,95%CI:1.65~2.79)、胆道手术史(OR=10.90,95%CI:6.07~19.56)、胆道积气(OR=2.05,95%CI:1.52~2.77)、乳头大切开(OR=2.80,95%CI:1.61~4.84)、老年人(OR=1.62,95%CI:1.13~2.31)等因素与ERCP术后胆总管结石复发高度相关.结论 ERCP取石后胆总管结石复发受多种因素影响,应当根据具体情况采用针对性措施降低复发率.

Risk factors of postoperative recurrence of common bile duct stones in patients with endoscopic retrograde cholangiopancreatography lithotomy: a meta-analysis

Objective To evaluate the risk factors for the recurrence of the common bile duct (CBD) stones af-ter endoscopic retrograde cholangiopancreatography (ERCP) lithotomy through a meta-analysis method, and to provide a reference for preventing recurrence. Methods We searched the document literature in PubMed, Cochrane Library,EMbase, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wan-fang database, and extracted data in studies which met the criteria for inclusion and exclusion, and finally used RevMan 5.3 software to do a meta-analysis. Results A total of 18 retrospective case control studies with 10797 cases were enrolled. The results of meta-analysis revealed that the highly correlated factors of CBD stones recurrence after ERCP lithotomy included peri-papillary diverticulum (OR=2.44, 95%CI:1.85-3.22), preoperative multiple stones (OR=1.63, 95%CI:1.20-2.20), pre-operative stone diameter>1 cm (OR=2.53, 95%CI:1.73-3.70), common bile duct diameter>15mm (OR=2.39, 95%CI:1.84-3.11), merging the gallbladder stones (OR=1.20, 95% CI: 0.82-1.76), biliary stricture (OR=2.70, 95% CI:1.66-4.41), mechanical lithotripsy (OR=2.15, 95% CI: 1.65-2.79), biliary surgery history (OR=10.90, 95% CI:6.07-19.56), biliary pneumatosis (OR=2.05, 95%CI:1.52-2.77), large nipple incision (OR=2.80, 95%CI:1.61-4.84), the elderly (OR=1.62, 95%CI:1.13-2.31). Conclusion Postoperative stone recurrence in patients undergoing ERCP li-thotomy is affected by many kinds of factors, so the targeted measures should be adopted to reduce the recurrence rate.