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腹腔镜下胆道镜联合钬激光碎石术与传统开腹手术治疗胆管结石效果比较的Meta分析

牛向东 余静 汪旭云 陈一锋 马世勋 丁国淦 苗长丰 王晓鹏 苏河

引用本文:
Citation:

腹腔镜下胆道镜联合钬激光碎石术与传统开腹手术治疗胆管结石效果比较的Meta分析

DOI: 10.3969/j.issn.1001-5256.2023.10.021
基金项目: 

甘肃省人民医院重点研发项目 (17GSSY3-2);

甘肃省自然科学基金 (20JR10RA381);

甘肃省人民医院院内青年项目 (21GSSYC-17)

利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:牛向东、余静、汪旭云负责课题设计,资料分析,撰写论文;陈一锋、马世勋、丁国淦、苗长丰参与收集数据,修改论文;王晓鹏、苏河负责拟定写作思路,指导撰写文章并最后定稿。牛向东、余静为共同第一作者;王晓鹏、苏河为共同通信作者。
详细信息
    通信作者:

    王晓鹏, wxpjm78@163.com (ORCID: 0009-0002-3712-8975)

    苏河, 13321217149@163.com (ORCID: 0009-0007-7481-5041)

Efficacy of laparoscopic choledochoscopy combined with holmium laser lithotripsy versus traditional laparotomy in treatment of bile duct stones: A Meta-analysis

Research funding: 

‍Gansu Provincial Hospital Key Research Project (17GSSY3-2);

Gansu Provincial Natural Science Foundation (20JR10RA381);

Gansu Provincial Hospital Youth Project (21GSSYC-17)

More Information
  • 摘要:   目的  通过Meta分析系统评价腹腔镜下胆道镜联合钬激光碎石术的有效性及安全性。  方法  本研究根据PRISMA指南完成,PROSPERO注册号:CRD42023406221。计算机检索中国知网、万方、维普等中文数据库以及PubMed、Embase、Cochrane Library、Web of Science等外文数据库中比较传统开腹手术与腹腔镜联合胆道镜钬激光治疗胆管结石的原始文献,通过优势比(OR)和95%可信区间(95%CI)评估二分类变量,通过加权平均差(WMD)和95%CI评估连续性变量,并对异质性较高结局指标进行敏感性分析。Begg检验和Egger检验用于评估发表偏倚。应用Stata 15.0软件和Review Manager 5.3软件进行统计分析。  结果  纳入来自中国的29项回顾性研究,共2 511例患者。Meta分析结果显示,与传统开腹手术相比,腹腔镜联合胆道镜钬激光治疗胆管结石的手术时间(WMD=-1.26,95%CI:-1.36~-1.16,P<0.001)、住院时间(WMD=-1.93,95%CI:-2.64~-1.12,P<0.001)及肠道功能恢复时间(WMD=-1.52,95%CI:-1.68~-1.35,P<0.001)更短,术中出血量更少(WMD=-1.79,95%CI:-1.93~-1.66,P<0.001),术中残石率更低(OR=0.15,95%CI:0.11~0.20,P<0.001),并发症更少(OR=0.17,95%CI:0.13~0.23,P<0.001)。  结论  相比于传统开腹手术治疗胆管结石,腹腔镜联合胆道镜钬激光治疗胆管结石显示出更好的有效性。

     

  • 图  1  文献筛选流程图

    Figure  1.  Flow chart of studies identified

    图  2  手术时间的Meta分析结果

    Figure  2.  Meta-analysis result of operation time

    图  3  术中出血量的Meta分析结果

    Figure  3.  Meta-analysis result of intraoperative bleeding

    图  4  术后残石率的Meta分析结果

    Figure  4.  Meta-analysis result of postoperative residual stone rate

    图  5  总并发症的Meta分析结果

    Figure  5.  Meta-analysis result of total complications

    图  6  住院时间的Meta分析结果

    Figure  6.  Meta-analysis result of length of hospitalization

    图  7  肛门排气时间的Meta分析结果

    Figure  7.  Meta-analysis result of anal venting time

    图  8  敏感性分析

    注: a,手术时间;b,术中出血量;c,住院时间;d,肛门排气时间。

    Figure  8.  Sensitivity analysis

    图  9  术后残石率发表偏倚

    注: a,Begg检验;b,Egger检验。

    Figure  9.  Publication bias: Postoperative residual stone rate

    表  1  纳入文献基本特征及NOS评分

    Table  1.   Basic characteristics and NOS score of the included study

    第一作者 发表年份 研究类型 样本量(例) 年龄(岁) 男/女(例) 结局指标 NOS评分
    试验组 对照组 试验组 对照组 试验组 对照组
    王建11 2013 回顾性研究 34 31 28~721) 28/371) c,d 5
    赵守和12 2013 回顾性研究 40 40 46.00±13.19 47.70±16.13 18/22 16/24 a,b,c,d,e,f 7
    唐滔13 2013 回顾性研究 60 64 46.5±4.2 48.5±3.5 36/24 42/22 a,c,d,e 6
    叶进军14 2014 回顾性研究 84 79 20~81 22~79 53/31 43/36 a,c,d,e 7
    田志强15 2014 回顾性研究 55 55 56.2±7.4 54.7±5.2 25/30 26/29 a,c,d,e,f 9
    程伟16 2014 回顾性研究 55 55 45.62±9.16 45.13±9.21 32/23 33/22 a,b,c,d 7
    刘汉东17 2014 回顾性研究 25 25 22~76 23~74 14/11 13/12 a,c,d,e 6
    刘国生18 2015 回顾性研究 56 56 42.1±4.2 42.5±4.3 30/26 31/25 a,b,c,d,e 8
    徐键19 2015 回顾性研究 30 30 47.9±3.6 47.8±3.5 17/13 16/14 a,c,d,e 8
    廖文鹏20 2015 回顾性研究 40 38 65~83 65~83 42/361) a,c,d,e 6
    李信21 2015 回顾性研究 37 37 46.8±5.21) 43/311) a,b,c,d,e 8
    何恒正22 2015 回顾性研究 64 64 56.2±4.7 54.7±5.2 39/25 39/25 a,b,c,d 7
    温志华23 2017 回顾性研究 50 50 47±7 49±6 30/20 28/22 a,b,c,d 8
    陈季云24 2016 回顾性研究 30 30 44.3±4.11) 32/281) a,b,c,d,f 7
    郑红军25 2016 回顾性研究 37 37 48.5±4.2 46.5±3.5 17/20 19/18 a,c,d,e 7
    张文培26 2016 回顾性研究 54 54 42.9±4.11) 68/401) c,d 6
    景东帅27 2017 回顾性研究 25 20 51.12±6.13 49.25±7.55 16/9 12/8 a,b,c,d,e 9
    吕述明28 2017 回顾性研究 30 30 49.5±2.5 49.2±2.7 17/13 16/14 a,b,c,d 8
    孙大华29 2018 回顾性研究 33 33 55.19±10.37 56.17±11.03 14/19 13/20 a,b,c,d,e 7
    刘旸30 2018 回顾性研究 70 70 52.34±13.35 53.34±13.49 45/25 43/27 a,c,d,e 9
    贺志敬31 2020 回顾性研究 33 32 22~75 21~74 21/12 18/14 a,b,c,d,e,f 8
    罗泽斌32 2020 回顾性研究 45 45 49.70±10.02 50.78±9.39 28/17 25/20 a,b,c,d,e,f 8
    姚伟旗33 2021 回顾性研究 47 46 56.58±6.31 55.62±6.17 33/14 31/15 a,b,c,d,e,f 8
    张国军34 2021 回顾性研究 36 37 46.41±7.17 46.37±7.22 19/17 18/19 c,d 8
    李林峰35 2022 回顾性研究 23 20 46.11±10.89 47.25±10.75 10/13 7/13 a,b,c,d,f 7
    王海平36 2022 回顾性研究 34 33 49.76±11.73 49.47±12.36 22/12 20/13 a,b,c,d,f 8
    何圣敏37 2022 回顾性研究 54 49 47.11±8.35 45.63±11.73 33/21 29/20 a,b,d,e,f 7
    尚宾38 2022 回顾性研究 65 60 52.38±9.49 52.37±9.74 26/39 24/36 a,b,c,d,e,f 6
    邱伟39 2022 回顾性研究 25 25 55.73±5.21 55.62±5.30 15/10 13/12 a,b,c,e 6
    注:1)纳入文献中未分组描述年龄或男女例数;a,手术时间;b,术中出血量;c,术后残石率;d,总并发症;e,住院时间;f,肛门排气时间。
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