Moqbel Ibrahim, Albashier Mahmoud, Tawadros Mario Maged, Helal Mohamed Basyouni, Abdelbaset Ahmed Hussein, Abdelmeguid Ahmed Ihab, Abdalqader Razan Sulieman, Youssef Mohamed Youssef Abdou, Elsayed Ashraf Abdelmonem
Faculty of Medicine, Cairo University, Cairo, Egypt.
Faculty of Medicine, Damietta University, New Damietta, Egypt.
Surg Endosc. 2025 Sep 2. doi: 10.1007/s00464-025-12132-2.
Laparoscopic cholecystectomy (LC) is the current gold standard for the management of acute cholecystitis, where ultrasonic dissection and electrocautery dissection are the two primary techniques used, however, it remains uncertain which approach is safer and more effective.
This systematic review and meta-analysis aimed to compare the clinical outcomes of ultrasonic dissection versus electrocautery dissection in LC for acute cholecystitis, particularly in operative time, hospital stay, blood loss, intraoperative and postoperative complications.
A systematic literature search was conducted in PubMed (MEDLINE), Scopus, Web of Science (WOS), EMBASE, and Cochrane CENTRAL up to January 7, 2025, following PRISMA guidelines. Eligible studies were randomized controlled trials (RCTs) comparing ultrasonic dissection and electrocautery dissection in LC for acute cholecystitis. Data extraction and risk-of-bias assessment were independently performed. Statistical analyses were conducted using Review Manager (RevMan 5.4), with heterogeneity assessed using I statistics and a random-effects model where necessary.
A total of 28 RCTs, comprising 3383 patients (1720 in the ultrasonic dissection group and 1663 in the electrocautery group), were included. The meta-analysis demonstrated that ultrasonic dissection significantly reduced operative time (- 9.13 min, 95% CI - 9.65 to - 8.61, p < 0.0001, I = 97%), hospital stay (- 0.95 days, 95% CI - 1.74 to - 0.17, p = 0.02, I = 100%), and blood loss (- 27.60 ml, 95% CI - 38.48 to - 16.72, p < 0.00001, I = 98%). Subgroup analysis reduced heterogeneity in some outcomes. Risk-of-bias assessment showed variability in study quality, with concerns in allocation concealment and performance bias in certain RCTs.
Ultrasonic dissection demonstrated advantages over electrocautery dissection for laparoscopic cholecystectomy in patients with acute cholecystitis, including reduced operative time, lower blood loss, and shorter hospital stays. While some heterogeneity was observed among studies, ultrasonic dissection appears to be a safer and more efficient technique.
腹腔镜胆囊切除术（LC）是目前治疗急性胆囊炎的金标准，其中超声刀分离和电刀分离是两种主要技术，但哪种方法更安全、更有效仍不确定。
本系统评价和荟萃分析旨在比较超声刀分离与电刀分离在急性胆囊炎LC中的临床结局，特别是手术时间、住院时间、失血量、术中及术后并发症。
按照PRISMA指南，截至2025年1月7日，在PubMed（MEDLINE）、Scopus、科学引文索引（WOS）、EMBASE和Cochrane CENTRAL中进行系统文献检索。纳入的合格研究为比较超声刀分离与电刀分离在急性胆囊炎LC中的随机对照试验（RCT）。独立进行数据提取和偏倚风险评估。使用Review Manager（RevMan 5.4）进行统计分析，必要时使用I统计量和随机效应模型评估异质性。
共纳入28项RCT，包括3383例患者（超声刀分离组1720例，电刀分离组1663例）。荟萃分析表明，超声刀分离显著缩短了手术时间（-9.13分钟，95%CI -9.65至-8.61，p<0.0001，I=97%）、住院时间（-0.95天，95%CI -1.74至-0.17，p=0.02，I=100%）和失血量（-27.60毫升，95%CI -38.48至-16.72，p<0.00001，I=98%）。亚组分析降低了某些结局的异质性。偏倚风险评估显示研究质量存在差异，某些RCT在分配隐藏和实施偏倚方面存在问题。
对于急性胆囊炎患者的腹腔镜胆囊切除术，超声刀分离比电刀分离具有优势，包括缩短手术时间、减少失血量和缩短住院时间。虽然研究之间存在一些异质性，但超声刀分离似乎是一种更安全、更有效的技术。
