Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free Campus, University College London Medical School, London, UK.
Br J Surg. 2011 Jul;98(7):908-16. doi: 10.1002/bjs.7460. Epub 2011 Apr 7.
Most patients with gallbladder and common bile duct stones are treated by preoperative endoscopic sphincterotomy (POES) followed by laparoscopic cholecystectomy. Recently, intraoperative endoscopic sphincterotomy (IOES) during laparoscopic cholecystectomy has been suggested as an alternative treatment.
Data from randomized clinical trials related to safety and effectiveness of IOES versus POES were extracted by two independent reviewers. Risk ratios (RRs) or mean differences were calculated with 95 per cent confidence intervals based on intention-to-treat analysis whenever possible.
Four trials with 532 patients comparing IOES with POES were included. There were no deaths. There was no significant difference in rates of ampullary cannulation (RR 1·01, 0·97 to 1·04; P = 0·70) or stone clearance by ES (RR 0·99, 0·96 to 1·02; P = 0·58) between the groups. The proportion of patients with at least one post-ES complication, including pancreatitis, bleeding, perforation, cholangitis, cholecystitis or gastric ulcer, was significantly lower in the IOES group (RR 0·37, 0·18 to 0·78; P = 0·009). There was no significant difference in morbidity after laparoscopic cholecystectomy or requirement for open operation between the groups. Mean hospital stay was 3 days shorter in the IOES group: mean difference - 2·83 (-3·66 to - 2·00) days (P < 0·001).
In patients with gallbladder and common bile duct stones, IOES is as effective and safe as POES and results in a significantly shorter hospital stay.
大多数胆囊和胆总管结石患者采用术前内镜下括约肌切开术（POES）联合腹腔镜胆囊切除术进行治疗。最近，腹腔镜胆囊切除术中的内镜下括约肌切开术（IOES）被提议作为替代治疗方法。
两位独立的评审员提取了与 IOES 与 POES 的安全性和有效性相关的随机临床试验数据。尽可能根据意向治疗分析，计算风险比（RR）或均数差值及其 95%置信区间。
纳入了 4 项比较 IOES 与 POES 的试验，共纳入 532 例患者。研究中无死亡病例。两组之间的乳头插管率（RR 1·01，0·97 至 1·04；P = 0·70）或内镜下括约肌切开术取石率（RR 0·99，0·96 至 1·02；P = 0·58）均无显著差异。内镜下括约肌切开术后至少有一项并发症的患者比例，包括胰腺炎、出血、穿孔、胆管炎、胆囊炎或胃溃疡，IOES 组显著更低（RR 0·37，0·18 至 0·78；P = 0·009）。两组之间腹腔镜胆囊切除术后的发病率或需要开腹手术无显著差异。IOES 组的平均住院时间缩短了 3 天：平均差值 - 2·83（-3·66 至 - 2·00）天（P < 0·001）。
对于胆囊和胆总管结石患者，IOES 与 POES 一样有效且安全，并可显著缩短住院时间。
