輕型膽源性胰腺炎患者早期和延期行腹腔鏡膽囊切除術的Meta分析

田國江，黃劍飛，徐捷，周蒙滔(溫州醫科大學附屬第一醫院肝膽外科，浙江溫州325000)

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輕型膽源性胰腺炎患者早期和延期行腹腔鏡膽囊切除術的Meta分析

田國江，黃劍飛，徐捷，周蒙滔
(溫州醫科大學附屬第一醫院肝膽外科，浙江溫州325000)

[摘 要]目的 評價和比較輕型膽源性胰腺炎患者在入院48 h內(早期組)與入院48 h后(延期組)行腹腔鏡下膽囊切除術的安全性和有效性。方法 計算機檢索PubMed、Cochrane Library、Embase上搜索所有相關的英文文獻(1990年1月至2015年1月)，并運用RevMan5.3軟件進行統計學分析。結果 共納入5篇文獻(3篇觀察性試驗，2篇隨機對照試驗)，共679例患者。Meta結果顯示，與延期組相比，早期組在ERCP的總共使用上少于延期組(OR=0.54，95%CI:0.36～0.80，P=0.002)。二者在術后并發癥、中轉開腹率、術后ERCP的使用和再入院率方面差異無統計學意義(P＞0.05)。雖然在住院時間上缺乏數據進行Meta分析，但每篇文獻均顯示早期組少于延期組，差異具有統計學意義(P＜0.05)。未有死亡病例發生。結論 對于輕型膽源性胰腺炎患者，入院48 h內進行腹腔鏡下膽囊切除術是安全、有效的。

[關鍵詞]膽囊切除術，腹腔鏡；胰腺炎；膽結石；Meta分析

Earlyverus late laparoscopic cholecystectomy in patients with mild gallstone pancreatitis:a systematic review and Meta-analysis

TIAN Guo-jiang, HUANG Jian-fei, XU Jie, ZHOU Meng-tao.Department of Hepatobiliary Surgery, The First Af■liated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

Abstract ObjectiveTo evaluate and compare the safety and ef■ciency of laparoscopic cholecystectomy (LC) within 48 h after index admission (early group) versus a late one (late group) in patient with acute mild gallstone pancreatitis.MethodsAll the relevant English articles from the PubMed, Cochrane Library, EMBASE were searched (Jan.1990 to Jan.2015).The Cochrane Collaboration’s software RevMan 5.3 was used for Metaanalysis.ResultsFive articles (3 were observational trials and 2 were randomized controlled clinical trials) totaling 679 patients were included.The outcome showed that the total use of ERCP was signi■cantly lower in the early group compared with the late group (OR=0.54； 95%CI:0.36～0.80, P=0.002).No statistically signi■cant differences were found in postoperative complication, conversion rate, the use of postoperative ERCP and readmission rate.Although there were no enough data to perform a meta-analysis in the length of hospital stay, which was statistically signi■cant decreased in the early group compared with the late group for each study (P＜0.05).No death occurred.ConclusionEarly laparoscopic cholecystectomy (＜48 h) in patients with mild gallstone pancreatitis is safe and ef■cient.

Key words laparoscopic cholecystectomy；pancreatitis； gallstone；Meta-analysis

急性胰腺炎是臨床常見的急腹癥之一，為胰酶異常激活后對胰腺及其周圍臟器產生自身消化作用而引起的炎癥性疾病。大約80%患者為輕型，剩余20%為重型，有較高的病死率。膽源性胰腺炎是急性胰腺炎的常見類型，其首要治療是對癥支持治療，但切除膽囊被認為是阻止胰腺炎再發的決定性的治療方式。盡管1%～2%的患者在切除膽囊后仍然可能再發胰腺炎，但是那些僅做ERCP治療和僅保守治療胰腺炎的再發率可分別高達10%和33%[1]。……