Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.
Br J Surg. 2013 Jan;100(2):209-16. doi: 10.1002/bjs.8911. Epub 2012 Oct 3.
Open cholecystectomy (OC) is often preferred over laparoscopic cholecystectomy (LC) in patients with liver cirrhosis and portal hypertension, but evidence is lacking to support this practice. This meta-analysis aimed to clarify which surgical technique is preferable for symptomatic cholecystolithiasis in patients with liver cirrhosis.
A meta-analysis was conducted according to the PRISMA guidelines. Articles published between January 1990 and October 2011 were identified from MEDLINE, Embase and the Cochrane Library. Randomized clinical trials (RCTs) comparing outcomes of OC versus LC for cholecystolithiasis in patients with liver cirrhosis were included. The quality of the RCTs was assessed using the Jadad criteria.
Following review of 1422 papers by title and abstract, a meta-analysis was conducted of four RCTs comprising 234 surgical patients. They provided evidence of at least level 2b on the Oxford Level of Evidence Scale, but scored poorly according to the Jadad criteria. Some 97·0 per cent of the patients had Child-Turcotte-Pugh (CTP) grade A or B liver cirrhosis. In all, 96·6 per cent underwent elective surgery. No postoperative deaths were reported. LC was associated with fewer postoperative complications (risk ratio 0·52, 95 per cent confidence interval (c.i.) 0·29 to 0·92; P = 0·03), a shorter hospital stay (mean difference -3·05 (95 per cent c.i. -4·09 to -2·01) days; P < 0·001) and quicker resumption of a normal diet (mean difference -27·48 (-30·96 to -23·99) h; P < 0·001).
Patients with CTP grade A or B liver cirrhosis who undergo LC for symptomatic cholecystolithiasis have fewer overall postoperative complications, a shorter hospital stay and resume a normal diet more quickly than those who undergo OC.
在患有肝硬化和门静脉高压的患者中，开腹胆囊切除术（OC）通常优于腹腔镜胆囊切除术（LC），但缺乏支持这种做法的证据。本荟萃分析旨在阐明哪种手术技术更适合肝硬化患者的症状性胆囊结石。
根据 PRISMA 指南进行荟萃分析。从 MEDLINE、Embase 和 Cochrane 图书馆检索 1990 年 1 月至 2011 年 10 月发表的文章。纳入比较肝硬化患者胆囊结石 OC 与 LC 结果的随机临床试验（RCT）。使用 Jadad 标准评估 RCT 的质量。
经标题和摘要审查后，共纳入了 4 项 RCT（共 234 例手术患者）进行荟萃分析。这些 RCT 提供了至少牛津证据等级 2b 级别的证据，但根据 Jadad 标准评分较差。大约 97.0%的患者患有 Child-Turcotte-Pugh（CTP）分级 A 或 B 肝硬化。所有患者均行择期手术，无术后死亡病例报告。LC 术后并发症较少（风险比 0.52，95%置信区间 0.29 至 0.92；P = 0.03），住院时间较短（平均差-3.05 天，95%置信区间-4.09 至-2.01 天；P < 0.001），正常饮食恢复较快（平均差-27.48 小时，-30.96 至-23.99 小时；P < 0.001）。
对于有症状性胆囊结石的 CTP 分级 A 或 B 肝硬化患者，LC 比 OC 术后总体并发症更少，住院时间更短，正常饮食恢复更快。
