Keus F, de Jong J A F, Gooszen H G, van Laarhoven C J H M
Diakonessenhuis, Surgery, Bosboomstraat 1, Utrecht, Netherlands.
Cochrane Database Syst Rev. 2006 Oct 18(4):CD006231. doi: 10.1002/14651858.CD006231.
Cholecystectomy is one of the most frequently performed operations. Open cholecystectomy has been the gold standard for over 100 years. Laparoscopic cholecystectomy was introduced in the 1980s.
To compare the beneficial and harmful effects of laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis.
We searched TheCochrane Hepato-Biliary Group Controlled Trials Register (April 2004), The Cochrane Library (Issue 1, 2004), MEDLINE (1966 to January 2004), EMBASE (1980 to January 2004), Web of Science (1988 to January 2004), and CINAHL (1982 to January 2004) for randomised trials.
All published and unpublished randomised trials in patients with symptomatic cholecystolithiasis comparing any kind of laparoscopic cholecystectomy versus any kind of open cholecystectomy. No language limitations were applied.
Two authors independently performed selection of trials and data extraction. The methodological quality of the generation of the allocation sequence, allocation concealment, blinding, and follow-up was evaluated to assess bias risk. Analyses were based on the intention-to-treat principle. Authors were requested additional information in case of missing data. Sensitivity and subgroup analyses were performed when appropriate.
Thirty-eight trials randomised 2338 patients. Most of the trials had high bias risk. There was no significant difference regarding mortality (risk difference 0,00, 95% confidence interval (CI) -0.01 to 0.01). Meta-analysis of all trials suggests less overall complications in the laparoscopic group, but the high-quality trials show no significant difference ('allocation concealment' high-quality trials risk difference, random effects -0.01, 95% CI -0.05 to 0.02). Laparoscopic cholecystectomy patients have a shorter hospital stay (weighted mean difference (WMD), random effects -3 days, 95% CI -3.9 to -2.3) and convalescence (WMD, random effects -22.5 days, 95% CI -36.9 to -8.1) compared to open cholecystectomy.
AUTHORS' CONCLUSIONS: No significant differences were observed in mortality, complications and operative time between laparoscopic and open cholecystectomy. Laparoscopic cholecystectomy is associated with a significantly shorter hospital stay and a quicker convalescence compared with the classical open cholecystectomy. These results confirm the existing preference for the laparoscopic cholecystectomy over open cholecystectomy.
胆囊切除术是最常施行的手术之一。开放式胆囊切除术在100多年来一直是金标准。腹腔镜胆囊切除术于20世纪80年代被引入。
比较腹腔镜与开放式胆囊切除术对有症状胆囊结石患者的有益和有害影响。
我们检索了Cochrane肝胆组对照试验注册库（2004年4月）、Cochrane图书馆（2004年第1期）、医学索引数据库（1966年至2004年1月）、荷兰医学文摘数据库（1980年至2004年1月）、科学引文索引数据库（1988年至2004年1月）和护理学与健康领域数据库（1982年至2004年1月）以查找随机试验。
所有已发表和未发表的针对有症状胆囊结石患者比较任何类型腹腔镜胆囊切除术与任何类型开放式胆囊切除术的随机试验。不设语言限制。
两位作者独立进行试验选择和数据提取。评估分配序列产生、分配隐藏、盲法和随访的方法学质量以评估偏倚风险。分析基于意向性治疗原则。如有数据缺失，要求作者提供额外信息。在适当情况下进行敏感性和亚组分析。
38项试验将2338例患者随机分组。大多数试验存在高偏倚风险。死亡率方面无显著差异（风险差值0.00，95%置信区间（CI）-0.01至0.01）。所有试验的荟萃分析表明腹腔镜组总体并发症较少，但高质量试验显示无显著差异（“分配隐藏”高质量试验风险差值，随机效应-0.01，95%CI-0.05至0.02）。与开放式胆囊切除术相比，腹腔镜胆囊切除术患者的住院时间较短（加权均数差值（WMD），随机效应-3天，95%CI-3.9至-2.3）且康复时间较短（WMD，随机效应-22.5天，95%CI-36.9至-8.1）。
腹腔镜与开放式胆囊切除术在死亡率、并发症和手术时间方面未观察到显著差异。与传统开放式胆囊切除术相比，腹腔镜胆囊切除术的住院时间显著缩短且康复更快。这些结果证实了目前对腹腔镜胆囊切除术优于开放式胆囊切除术的偏好。
