急性胆囊炎早期与延迟腹腔镜胆囊切除术的安全性、转化率及住院时间比较：一项系统评价与Meta分析

Comparison of the safety profile, conversion rate and hospitalization duration between early and delayed laparoscopic cholecystectomy for acute cholecystitis: a systematic review and meta-analysis.

作者信息

Wu Hongsheng, Liao Biling, Cao Tiansheng, Ji Tengfei, Huang Jianbin, Luo Yumei, Ma Keqiang

机构信息

Department of Hepatobiliary Pancreatic Surgery, Affiliated Huadu Hospital, Southern Medical University, Guangzhou, China.

出版信息

Front Med (Lausanne). 2023 Dec 11;10:1185482. doi: 10.3389/fmed.2023.1185482. eCollection 2023.

DOI:10.3389/fmed.2023.1185482

PMID:38148916

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10750350/

Abstract

BACKGROUND

Although the past decade has witnessed unprecedented medical progress, no consensus has been reached on the optimal approach for patients with acute cholecystitis. Herein, we conducted a systematic review and meta-analysis to assess the differences in patient outcomes between Early Laparoscopic Cholecystectomy (ELC) and Delayed Laparoscopic Cholecystectomy (DLC) in the treatment of acute cholecystitis. Our protocol was registered in the PROSPERO database (registration number: CRD42023389238).

OBJECTIVES

We sought to investigate the differences in efficacy, safety, and potential benefits between ELC and DLC in acute cholecystitis patients by conducting a systematic review and meta-analysis.

METHODS

The online databases PubMed, Springer, and the Cochrane Library were searched for randomized controlled trials (RCTs) and retrospective studies published between Jan 1, 1999 and Jan 1, 2022.

RESULTS

21 RCTs and 13 retrospective studies with a total of 7,601 cases were included in this research. After a fixed-effects model was applied, the pooled analysis showed that DLC was associated with a significantly high conversion rate (OR: 0.6247; 95%CI: 0.5115-0.7630; z = -4.61, < 0.0001) and incidence of postoperative complications (OR: 0.7548; 95%CI: 0.6197-0.9192; z = -2.80, = 0.0051). However, after applying a random-effects model, ELC was associated with significantly shorter total hospitalization duration than DLC (MD: -4.0657; 95%CI: -5.0747 to -3.0566; z = -7.90, < 0.0001).

CONCLUSION

ELC represents a safe and feasible approach for acute cholecystitis patients since it shortens hospitalization duration and decreases the incidence of postoperative complications of laparoscopic cholecystectomy.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=389238, identifier (CRD42023389238).

摘要

背景

尽管过去十年见证了前所未有的医学进步，但对于急性胆囊炎患者的最佳治疗方法尚未达成共识。在此，我们进行了一项系统评价和荟萃分析，以评估早期腹腔镜胆囊切除术（ELC）和延迟腹腔镜胆囊切除术（DLC）在治疗急性胆囊炎时患者预后的差异。我们的方案已在PROSPERO数据库中注册（注册号：CRD42023389238）。

目的

我们试图通过进行系统评价和荟萃分析，研究ELC和DLC在急性胆囊炎患者中的疗效、安全性和潜在益处的差异。

方法

检索在线数据库PubMed、Springer和Cochrane图书馆，查找1999年1月1日至2022年1月1日期间发表的随机对照试验（RCT）和回顾性研究。

结果

本研究纳入了21项RCT和13项回顾性研究，共7601例病例。应用固定效应模型后，汇总分析显示DLC的转化率显著较高（OR：0.6247；95%CI：0.5115 - 0.7630；z = -4.61，P < 0.0001）以及术后并发症发生率较高（OR：0.7548；95%CI：0.6197 - 0.9192；z = -2.80，P = 0.0051）。然而，应用随机效应模型后，ELC的总住院时间明显短于DLC（MD：-4.0657；95%CI：-5.0747至-3.0566；z = -7.90，P < 0.0001）。