School of Medicine, University of Liverpool, United Kingdom.
North West Schools of Surgery, Health Education England, Liverpool, United Kingdom.
Surgery. 2021 Oct;170(4):1014-1023. doi: 10.1016/j.surg.2021.03.036. Epub 2021 Apr 27.
Subtotal cholecystectomy is recognized as a rescue procedure performed in grossly suboptimal circumstances that would deem a total cholecystectomy too risky to execute. An earlier systematic review based on 30 studies published between 1985 and 2013 concluded that subtotal cholecystectomy had a morbidity rate comparable to that of total cholecystectomy. This systematic review appraises 17 clinical outcomes in patients undergoing subtotal cholecystectomy.
The study protocol was registered with the International Prospective Register for Systematic Reviews (CRD42020172808). MEDLINE, Embase, Cochrane bibliographic databases, and Google Scholar were used to identify papers published between 1985 and June 2020. Data related to the surgical setting, approach, intervention on the hepatic wall of the gallbladder, type of completion of subtotal cholecystectomy, year of study, and study design were collected. Seventeen clinical outcomes were considered. Meta-analyses were performed using a random-effects model, and the effect size was presented as risk ratios with 95% confidence intervals.
From 1,017 records, 85 eligible studies were identified and included. These included 3,645 patients who underwent subtotal cholecystectomy. Laparoscopic (80.1%, n = 2,918) and reconstituting (74.6%, n = 2,719) approaches represented the majority of all subtotal cholecystectomy cases. Seven (0.2%) cases of injury to the bile duct were reported. Bile leak was reported in 506 (13.9%) patients. Reconstituting subtotal cholecystectomy was associated with a lower risk for 11 clinical outcomes. Open subtotal cholecystectomy was associated with an increased rate of 30-day mortality and wound infections.
Subtotal cholecystectomy is associated with significant morbidity. Laparoscopic and reconstituting surgery may reduce the risks of some perioperative complications and long-term sequelae after subtotal cholecystectomy.
次全胆囊切除术被认为是一种在严重不理想的情况下进行的抢救手术，因为进行全胆囊切除术风险太大。一项基于 1985 年至 2013 年期间发表的 30 项研究的早期系统评价得出结论，次全胆囊切除术的发病率与全胆囊切除术相当。本系统评价评估了 17 项接受次全胆囊切除术患者的临床结局。
研究方案已在国际前瞻性系统评价注册库（CRD42020172808）中注册。使用 MEDLINE、Embase、Cochrane 文献数据库和 Google Scholar 检索 1985 年至 2020 年 6 月期间发表的论文。收集有关手术环境、手术方式、胆囊肝壁干预、次全胆囊切除术完成类型、研究年份和研究设计的数据。考虑了 17 项临床结局。使用随机效应模型进行荟萃分析，效应大小以风险比和 95%置信区间表示。
从 1017 条记录中，确定并纳入了 85 项符合条件的研究。这些研究包括 3645 例接受次全胆囊切除术的患者。腹腔镜（80.1%，n=2918）和重建（74.6%，n=2719）方法代表了所有次全胆囊切除术的大多数。报告了 7 例（0.2%）胆管损伤病例。报告了 506 例（13.9%）患者的胆漏。重建次全胆囊切除术与 11 项临床结局的风险降低相关。开放性次全胆囊切除术与 30 天死亡率和伤口感染的发生率增加相关。
次全胆囊切除术与显著的发病率相关。腹腔镜和重建手术可能会降低次全胆囊切除术后一些围手术期并发症和长期后遗症的风险。
