Cheng Yao, Xiong Xian-Ze, Wu Si-Jia, Lin Yi-Xin, Cheng Nan-Sheng
Department of Bile Duct Surgery, West China Hospital, Sichuan University, Sichuan Province, China.
Hepatogastroenterology. 2012 Sep;59(118):1727-34. doi: 10.5754/hge11688.
BACKGROUND/AIMS: To compare the safety and effectiveness of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) for cirrhotic patients.
The Cochrane Library, MEDLINE, Science Citation Index Expanded, EMBASE and CBM (Chinese Biomedical Database) were searched until August 2011 to indentify relevant and eligible studies.
Twenty three articles with 1316 cirrhotic patients were included. All patients were allocated to the LC group (n=694) or the OC group (n=622). They were primarily in Child-Pugh class A (n=957, 72.7%) and class B (n=343, 26.1%). Meta-analysis of 5 randomized controlled trials (n=284) indicated LC group was associated with the following advantages: significant lower surgery-related morbidity, less postoperative complications (e.g. incision hernia, wound infection), shorter hospital stay and less loss of blood. There were no significant differences in the intra-hospital mortality and total operative time between the two groups. Meta-analysis of 19 non-randomized studies (n=1082) showed similar results in favour of LC group. In addition, it showed significant lower intra-hospital mortality and less total operative time in the LC group than the OC group.
LC is safe and offers various significant benefits over OC. Thus, it should be recommended for compensated cirrhotic patients.
背景/目的：比较腹腔镜胆囊切除术（LC）与开腹胆囊切除术（OC）对肝硬化患者的安全性和有效性。
检索Cochrane图书馆、MEDLINE、科学引文索引扩展版、EMBASE和中国生物医学数据库（CBM）直至2011年8月，以确定相关且符合条件的研究。
纳入23篇文章，共1316例肝硬化患者。所有患者被分为LC组（n = 694）或OC组（n = 622）。他们主要为Child-Pugh A级（n = 957，72.7%）和B级（n = 343，26.1%）。对5项随机对照试验（n = 284）的荟萃分析表明，LC组具有以下优势：手术相关发病率显著降低、术后并发症（如切口疝、伤口感染）更少、住院时间更短且失血量更少。两组的院内死亡率和总手术时间无显著差异。对19项非随机研究（n = 1082）的荟萃分析显示了类似的结果，支持LC组。此外，结果显示LC组的院内死亡率显著低于OC组，且总手术时间更短。
LC是安全的，与OC相比有诸多显著益处。因此，对于代偿期肝硬化患者应推荐采用LC。
