胆总管结石取石术的Meta分析.docVIP

胆总管结石取石术的Meta分析 　　作者：殷建立,周秦蜀,凌永祥　　作者单位：上海中医药大学附属普陀医院普外科，上海 ;同济大学医学遗传所，上海 ;西安交通大学理学院，陕西西安 　　【摘要】 目的 比较胆总管结石的开腹手术治疗与内镜治疗的临床疗效。方法 通过电子检索和手工检索全面收集关于胆总管结石的开腹手术治疗和内镜治疗的随机对照实验，并按Cochrane协作网推荐的方法进行Meta分析。采用固定效应模型，对符合纳入标准的6个实验共407例患者进行Meta分析。结果 与ERCP内镜取石组相比较，开腹手术组在一次手术后结石残留率[OR 0.39, 95%CI (0.25，0.75), P=0.003]、患者再次手术率[OR 0.33, 95%CI (0.19, 0.60), P=0.0002]方面差异均有统计学意义，在围手术期并发症率方面[Peto OR 1.10, 95%CI (0.69,1.76), P=0.67]无统计学差异。结论 目前研究资料显示，开腹手术取石较内镜取石在结石清除效果方面有一定优势，而围手术期并发症率方面无统计学差异。 　　【关键词】 胆总管结石;胆总管切开探查术;内镜下括约肌切开术;内镜;Meta分析 　　Calculus removed for common bile duct stones: a metaanalysis 　　Yin Jianli, Zhou Qinshu, Ling Yongxiang 　　(Department of General Surgery, Putuo Hospital Affiliated to Shanghai Traditional　Chinese Medical University, Shanghai 200062; Institute of Medical Genetics, Tongji University, Shanghai 200092; School of Science,Xian Jiaotong University, Xian 710049, China) 　　ABSTRACT: Objective To compare the clinical effectivness of the treatment by open surgery and by therapeutic endoscopy for common bile duct (CBD) stones. Methods The randomised controlled trails on the open surgery or therapeutic endoscopy for CBD stones were identified by electronicsearching and handsearching, metaanalysis was conducted using the methods recommended by the Cochrane Collaboration. Data of 407 patients included in 6 highquality randomized controlled trials were metaanalyzed using in fixed effect model. Results Compared with endoscopic stone extraction technique, open surgery had retained stones after primary intervention rate (OR 0.39, 95% CI 0.25 to 0.75, P=0.003) and additional procedures rate (OR 0.33, 95% CI 0.19 to 0.60, P=0.0002) with statistical significance. But open surgery made no significant difference in postoperative complication rate (Peto OR 1.10, 95% CI 0.69 to 1.76, P=0.67). Conclusion Current evidence suggests that there is no significant difference between open surgery and therapeutic endoscopy in preoperative complications, but