Koh Ye Xin, Zhao Yun, Tan Ivan En-Howe, Tan Hwee Leong, Chua Darren Weiquan, Loh Wei-Liang, Tan Ek Khoon, Teo Jin Yao, Au Marianne Kit Har, Goh Brian Kim Poh
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, 20 College Road, Singapore, 169856, Singapore.
Duke-National University of Singapore Medical School, Singapore, Singapore.
Surg Endosc. 2024 Dec;38(12):7011-7023. doi: 10.1007/s00464-024-11336-2. Epub 2024 Oct 15.
BACKGROUND: This study sought to determine the optimal treatment strategy and timing for cholecystectomy in managing gallbladder diseases during pregnancy. It evaluated the effectiveness of conservative management (CM), laparoscopic cholecystectomy (LC), and open cholecystectomy (OC) in pregnancy and compared cholecystectomy outcomes across three trimesters. METHODS: Studies comparing CM, LC, and OC or evaluating cholecystectomy outcomes across trimesters were included in a literature search until February 2024. Studies included were required to have at least 10 cases per treatment group and perform statistical comparisons. Two Bayesian network meta-analyses (NMAs) were conducted, and surface under cumulative ranking area (SUCRA) values, risk ratio (RR), mean difference (MD), and 95% credible intervals (CrIs) were calculated for outcomes of interest. RESULTS: Our study included 17 studies with 63,523 pregnant patients. The first NMA included data from 12 studies involving 29,052 pregnant women, revealing that LC had the lowest risk for preterm delivery, significantly lower than CM (RR: 0.23, 95% CrI: 0.07-0.55). LC also had a significantly reduced risk of fetal complications (RR: 0.42, 95% CrI: 0.16-0.57) and maternal complications (RR: 0.44, 95% CrI: 0.15-0.50) compared to OC. LC was associated with a significantly shorter length of stay than OC (MD: -2.77, 95% CrI: -8.37 to -2.87). The second NMA analyzed data from five population-based studies with 34,471 pregnant patients, finding no significant differences in preterm delivery and abortion rates across the three trimesters following cholecystectomy. Cholecystectomy performed in the third trimester significantly increased the risk of maternal complications, with relative risks compared to first (RR: 0.48, 95% CrI: 0.22-1.00) and second trimesters (RR: 0.42, 95% CrI: 0.21-0.93). CONCLUSIONS: LC is deemed the optimal treatment for gallbladder diseases during pregnancy. While cholecystectomy is safe to be performed across all trimesters, careful deliberation is recommended during the third trimester due to an increased risk of maternal complications.
背景：本研究旨在确定妊娠期间胆囊疾病行胆囊切除术的最佳治疗策略和时机。评估保守治疗（CM）、腹腔镜胆囊切除术（LC）和开腹胆囊切除术（OC）在妊娠中的有效性，并比较三个孕期行胆囊切除术的结果。 方法：在文献检索中纳入比较CM、LC和OC或评估不同孕期胆囊切除术结果的研究，检索截至2024年2月。纳入的研究要求每个治疗组至少有10例病例并进行统计学比较。进行了两项贝叶斯网络荟萃分析（NMA），并计算了累积排序曲线下面积（SUCRA）值、风险比（RR）、平均差（MD）和95%可信区间（CrI）以得出感兴趣的结果。 结果：我们的研究纳入了17项研究，共63523例孕妇。第一项NMA纳入了12项研究的数据，涉及29052名孕妇，结果显示LC发生早产的风险最低，显著低于CM（RR：0.23，95%CrI：0.07 - 0.55）。与OC相比，LC发生胎儿并发症的风险也显著降低（RR：0.42，95%CrI：0.16 - 0.57）以及母体并发症的风险（RR：0.44，95%CrI：0.15 - 0.50）。LC的住院时间比OC显著缩短（MD： - 2.77，95%CrI： - 8.37至 - 2.87）。第二项NMA分析了五项基于人群的研究的数据，共34471例孕妇，发现在胆囊切除术后的三个孕期中，早产和流产率没有显著差异。在孕晚期进行胆囊切除术显著增加了母体并发症的风险，与孕早期相比相对风险为（RR：0.48，95%CrI：0.22 - 1.00），与孕中期相比为（RR：0.42，95%CrI：0.21 - 0.93）。 结论：LC被认为是妊娠期间胆囊疾病的最佳治疗方法。虽然在所有孕期进行胆囊切除术都是安全的，但由于孕晚期母体并发症风险增加，建议谨慎考虑。
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