胆总管结石取石术的Meta分析

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OR0.39,95%CI(0.25,0.75),P=0.003]、患者再次手术率OR0.33,95%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PetoOR1.10,95%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。

Calculus removed for common bile duct stones: a meta-analysis

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 open surgery is superior to therapeutic endoscopy in stone clearence rate.