General Surgery, The People's Hospital of Jiangyou, Sichuan Province, China.
Hepatobiliary Surgery, The People's Hospital of Jiangyou, Sichuan Province, China.
Medicine (Baltimore). 2023 Sep 8;102(36):e34884. doi: 10.1097/MD.0000000000034884.
Patients with cholecysto- and choledocholithiasis usually undergo endoscopic retrograde cholangiopancreatography (ERCP)/-endoscopic sphincterotomy followed by laparoscopic cholecystectomy (LC). However, differences in the timing of LC after the ERCP may alter the post-operative outcomes. The aim of this study was to compare the effect of early (≤3 days) or delayed LC (>3 days) following ERCP on the post-operative outcomes.
A comprehensive search of the 3 databases PubMed, EMBASE and the Cochrane Library was performed. Articles related to LC at different time-points after ERCP were retrieved. Dichotomous and continuous outcomes were analyzed by risk ratio (RR) and mean difference, and RevMan was used to analyze each group.
A total of 7 studies, including 5 randomized controlled studies and 2 retrospective studies, involved a total of 711 patients. There were 332 patients in early LC group and 379 in delayed LC group. The conversion rate was lower in the early LC group compared to the delayed LC group (RR 0.38, 95% confident interval 0.19 to 0.74, P = .005, I2 = 0%). Early LC resulted in a shorter operation time (RR -6.2, 95% CI -27.2 to -5.2, P = .004, I2 = 97%) and fewer complications (RR 0.48, 95% CI 0.29 to 0.79, P = .004, I2 = 17%). Subgroup analysis found that there were no significant differences in the conversion rate (RR 0.61, 95% CI 0.25 to 1.45, P = .26, I2 = 0%) or complications between the early LC group and the delayed group who underwent LC after 1 month.
Early LC after ERCP is the preferred treatment for patients with concurrent cholecysto- and choledocholithiasis due to improved clinical outcomes as compared to those who undergo delayed LC.
患有胆囊和胆总管结石的患者通常会接受内镜逆行胰胆管造影术（ERCP）/内镜下括约肌切开术，然后进行腹腔镜胆囊切除术（LC）。然而，ERCP 后 LC 的时间差异可能会改变术后结果。本研究旨在比较 ERCP 后早期（≤3 天）或延迟（>3 天）行 LC 对术后结果的影响。
对 PubMed、EMBASE 和 Cochrane 图书馆这 3 个数据库进行全面检索，检索与 ERCP 后不同时间点行 LC 相关的文章。采用风险比（RR）和均数差分析二分类和连续结局，RevMan 用于分析每组结果。
共纳入 7 项研究，包括 5 项随机对照研究和 2 项回顾性研究，共纳入 711 例患者。早期 LC 组 332 例，延迟 LC 组 379 例。早期 LC 组的中转率低于延迟 LC 组（RR 0.38，95%可信区间 0.19 至 0.74，P =.005，I2 = 0%）。早期 LC 可使手术时间更短（RR-6.2，95%CI-27.2 至-5.2，P =.004，I2 = 97%），并发症更少（RR 0.48，95%CI 0.29 至 0.79，P =.004，I2 = 17%）。亚组分析发现，1 个月后行 LC 的早期 LC 组和延迟 LC 组的中转率（RR 0.61，95%CI 0.25 至 1.45，P =.26，I2 = 0%）或并发症无显著差异。
与延迟 LC 相比，ERCP 后早期 LC 更有利于改善并发胆囊和胆总管结石患者的临床结局。
