摘要
目的:系统评价腹腔镜胆囊切除术中应用Rendezvous技术治疗胆囊结石合并胆总管结石的安全性和有效性.方法:检索Cochrane Library、Pub Med、Embase、中国生物医学数据库、CNKI、万方数据库、维普中文科技期刊数据库等,查找2006-02-31/2016-02-31公开发表的关于腹腔镜胆囊切除术中应用Rendezvous技术治疗胆囊结石合并胆总管结石的前瞻性随机对照试验(randomized controlled trials,RCT)研究,通过纳入和排除标准筛选文献,对纳入的研究进行分析并提取试验数据.采用Cochrane协助网的RevMan5.3.5软件进行数据分析.结果:本研究共纳入6篇R C T,纳入患者616例,其中应用Rendezvous技术307例,POERCP+L C为309例,Meta分析结果显示:Rendezvous组在结石清除率(OR=2.24,95%C I:1.26-4.65,P=0.08)、插管失败率(OR=0.39,95%CI:0.18-0.83,P=0.01)、术后总并发症发生率(OR=0.41,95%C I:0.22-0.75,P=0.004)等方面均优于POERCP+L C组,亚组分析表明相比POERCP+LC组,Rendezvous技术可有效降低ERCP相关并发症发生率,在LC相关并发症及中转开腹发生率差异无统计学意义(P>0.05).结论:腹腔镜胆囊切除术中联合内镜时应用Rendezvous技术优于POERCP+LC方案,该方案提高了结石清除率和插管成功率,并且可以降低ERCP相关的并发症发生率,缩短住院时间,但仍需大样本、多中心、前瞻性RCT研究来进一步说明两种方案的差异.
AIM： To systematically evaluate the efficacy and safety of the rendezvous technique for cholecystocholedocholithiasis during laparoscopic cholecystectomy（LC）. METHODS：From February 31,2006 to February 31, 2016, RCTs evaluating the rendezvous technique for cholecysto-choledocholithiasis during laparoscopic cholecystectomy were retrieved from Cochrane Library, Pub Med, Embase, CBM, CNKI database, Wanfang and VIP database. The data were extracted and analyzed using the Rev Man 5.3.5 software. RESULTS ： Six RCTs were enrolled in the meta-analysis. Among 616 patients analyzed, the rendezvous technique was used in 307 patients and POERCP ＋ LC in 309 patients. The results of meta-analysis showed significant differences between the rendezvous technique group and POERCP ＋ LC group regarding stone clearance rate（OR = 2.24, 95%CI： 1.26-4.65, P = 0.08）, cannulation failure rate（OR = 0.39, 95%CI： 0.18-0.83, P = 0.01）, and overall morbidity（OR = 0.41, 95%CI： 0.22-0.75, P = 0.004）. Sub-group analysis of morbidity also revealed significant differences between the rendezvous technique group and POERCP ＋ LC group regarding post-ERCP pancreatitis（OR = 0.15, 95%CI： 0.05-0.44, P = 0.0005） and hyperamylasemia（OR = 0.18, 95%CI： 0.09-0.36, P = 0.0001）, but the differences in the complication morbidity of LC and conversions rate were not significant（P〉0.05）.CONCLUSION： The rendezvous technique is superior to POERCP ＋ LC in terms of stone clearance, cannulation success, complication morbidity of ERCP and hospital stay. Large, multicenter prospective randomized controlled trials are still needed to confirm the findings of this meta-analysis.
出处
《世界华人消化杂志》
CAS
2016年第16期2563-2570,共8页
World Chinese Journal of Digestology
作者简介
余安，硕士，主要从事胆胰外科方面的研究
通讯作者：黄强，教授，主任医师，博士生导师，230001，安徽省合肥市庐江路17号，安徽医科大学附属省立医院普外科，肝胆胰安徽省重点实验室．hq—sohu@sohu．com
