早期腹腔镜胆囊切除术治疗轻度急性胆源性胰腺炎的安全性、可行性和成本效益：一项荟萃分析。

The safety, feasibility, and cost-effectiveness of early laparoscopic cholecystectomy for patients with mild acute biliary pancreatitis: A meta-analysis.

机构信息

Department of Surgery, Guangzhou United Family Hospital, China.

Department of Hepato-Biliary-Pancreatic Surgery, Hong Kong University Shenzhen Hospital, China.

出版信息

Surgeon. 2021 Oct;19(5):287-296. doi: 10.1016/j.surge.2020.06.014. Epub 2020 Jul 22.

DOI:10.1016/j.surge.2020.06.014

PMID:32709425

Abstract

BACKGROUND

It remains controversial on the optimal timing of cholecystectomy for patients with mild acute biliary pancreatitis. This study aimed at comparing the safety, feasibility, and cost-effectiveness of early laparoscopic cholecystectomy (ELC, within 72 h after admission) versus delayed laparoscopic cholecystectomy (DLC, beyond 72 h after admission) for patients with mild acute biliary pancreatitis.

METHODS

We performed a systematic search in the following databases: PubMed, Embase, Web of Science, and Cochrane library. We only included articles from RCTs which designed to evaluate the complications, conversion to open cholecystectomy, recurrence of acute pancreatitis, the length of hospital stay, and costs between patients undergoing ELC and those undergoing DLC. We schemed to analyze data using STATA 15.0 with both the random-effects and the fixed-effect models. We computed relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CI) based on the intention-to-treat (ITT) analysis.

RESULTS

A total of 4 studies involving 439 (215 vs 224) patients were included. The difference of complication rate [3.3% vs 3.2%; RR 1.03 (0.35, 3.01), P = 0.961] and rate of conversion to open cholecystectomy [3.8% vs 3.3%; RR 1.13 (0.37, 3.43), P = 0.830] are insignificant between patients who underwent ELC and ones who underwent DLC. The difference of rate of recurrence of acute pancreatitis is significant between ELC and DLC (2.17% vs 8.99%; RR 0.24 (0.08-0.70), P = 0.009). ELC does not shorten the length of hospital stay (random-effects model analysis: WMD -1.09 days (-2.67, 0.48), P = 0.173; fixed-effect model analysis: WMD -0.62 days (-1.00, -0.24), P = 0.001).

CONCLUSION

Compared to DLC, ELC is equally safe and feasible both in complication rate and rate of conversion to open procedure, and significantly reduces the recurrence rate of acute pancreatitis.

PROSPERO REGISTRATION NUMBER

CRD42018116239.

摘要

背景

对于轻度急性胆源性胰腺炎患者，胆囊切除术的最佳时机仍存在争议。本研究旨在比较早期腹腔镜胆囊切除术（入院后 72 小时内进行的 ELC）与延迟腹腔镜胆囊切除术（入院后 72 小时后进行的 DLC）在轻度急性胆源性胰腺炎患者中的安全性、可行性和成本效益。

方法

我们在以下数据库中进行了系统检索：PubMed、Embase、Web of Science 和 Cochrane 图书馆。我们只纳入了旨在评估并发症、转为开腹胆囊切除术、急性胰腺炎复发、住院时间和接受 ELC 与 DLC 的患者之间成本的 RCT 文章。我们计划使用 STATA 15.0 软件通过随机效应和固定效应模型分析数据。我们根据意向治疗（ITT）分析，使用 95%置信区间（CI）计算相对风险（RR）和加权均数差（WMD）。

结果

共有 4 项研究纳入 439 例（215 例 vs 224 例）患者。并发症发生率[3.3% vs 3.2%；RR 1.03（0.35，3.01），P=0.961]和转为开腹胆囊切除术的发生率[3.8% vs 3.3%；RR 1.13（0.37，3.43），P=0.830]差异无统计学意义。接受 ELC 和 DLC 的患者中，急性胰腺炎复发率差异有统计学意义（2.17% vs 8.99%；RR 0.24（0.08-0.70），P=0.009）。ELC 并不能缩短住院时间（随机效应模型分析：WMD-1.09 天（-2.67，0.48），P=0.173；固定效应模型分析：WMD-0.62 天（-1.00，-0.24），P=0.001）。