Clayton E S J, Connor S, Alexakis N, Leandros E
Department of Surgery, Christchurch Public Hospital, Christchurch, New Zealand.
Br J Surg. 2006 Oct;93(10):1185-91. doi: 10.1002/bjs.5568.
There is no clear consensus on the better therapeutic approach (endoscopic versus surgical) to choledocholithiasis. This study is a meta-analysis of the available evidence.
A search of the Medline and ISI databases identified 12 studies that met the inclusion criteria for data extraction. The analysis was performed using a random-effects model. The outcome was calculated as an odds ratio (OR) or relative risk (RR) with 95 per cent confidence intervals (c.i.).
Outcomes of 1357 patients were studied. There was no significant difference in successful duct clearance (OR 0.85 (95 per cent c.i. 0.64 to 1.12); P = 0.250), mortality (RR 1.79 (95 per cent c.i. 0.66 to 4.83); P = 0.250), total morbidity (RR 0.89 (95 per cent 0.71 c.i. to 1.13); P = 0.350), major morbidity (RR 1.34 (95 per cent c.i. 0.92 to 1.97); P = 0.130) or need for additional procedures (OR 1.37 (95 per cent c.i. 0.82 to 2.29); P = 0.230) between the endoscopic and surgical groups. There was also no significant difference between the endoscopic and laparoscopic surgery groups.
Both approaches have similar outcomes, and treatment should be determined by local resources and expertise.
对于胆总管结石更好的治疗方法（内镜治疗与手术治疗）尚无明确的共识。本研究是对现有证据的荟萃分析。
检索Medline和ISI数据库，确定了12项符合数据提取纳入标准的研究。采用随机效应模型进行分析。结果计算为比值比（OR）或相对危险度（RR），并给出95%置信区间（c.i.）。
对1357例患者的治疗结果进行了研究。在内镜治疗组和手术治疗组之间，胆管清除成功率（OR 0.85（95% c.i. 0.64至1.12）；P = 0.250）、死亡率（RR 1.79（95% c.i. 0.66至4.83）；P = 0.250）、总发病率（RR 0.89（95% c.i. 0.71至1.13）；P = 0.350）、严重发病率（RR 1.34（95% c.i. 0.92至1.97）；P = 0.130）或额外手术需求（OR 1.37（95% c.i. 0.82至2.29）；P = 0.230）方面均无显著差异。内镜治疗组和腹腔镜手术组之间也无显著差异。
两种治疗方法的结果相似，治疗应根据当地资源和专业知识来决定。
