Rendezvous nội soi - Laparoskopi so với ERCP kết hợp cắt bỏ túi mật nội soi trong điều trị sỏi mật cholecystocholedocholithiasis: một đánh giá hệ thống và phân tích mét-độ

Surgical Endoscopy And Other Interventional Techniques - Tập 34 - Trang 4214-4224 - 2020
Yan Lin1, Yan Su2, Jun Yan3, Xun Li1,4,5,6
1The First Clinical Medical College, Lanzhou University, Lanzhou, People’s Republic of China
2The First Hospital of Lanzhou University, Lanzhou, People’s Republic of China
3The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, People’s Republic of China
4The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, People’s Republic of China
5Key Laboratory of Biotherapy and Regenerative Medicine of Gansu Province, Lanzhou, People’s Republic of China
6Hepatopancreatobiliary Surgery Institute of Gansu Province, Medical College Cancer Center of Lanzhou, Lanzhou, People’s Republic of China

Tóm tắt

Quản lý lý tưởng cho bệnh nhân mắc chứng sỏi mật cholecystocholedocholithiasis vẫn đang gây tranh cãi. Rendezvous nội soi - Laparoskopi (LERV), kết hợp giữa nội soi và laparoscopy, là một kỹ thuật mới và hấp dẫn. Mục tiêu của nghiên cứu này là so sánh LERV với phương pháp điều trị truyền thống hai giai đoạn, bao gồm ERCP trước phẫu thuật và cắt bỏ túi mật nội soi (ERCP + LC), nhằm điều trị cho bệnh nhân bị sỏi mật cholecystocholedocholithiasis. Bốn cơ sở dữ liệu, bao gồm Thư viện Cochrane, PubMed, Embase và Medline, tất cả đều được cập nhật đến tháng 9 năm 2019, đã được tìm kiếm để xác định các nghiên cứu so sánh về LERV so với ERCP + LC trong điều trị sỏi mật cholecystocholedocholithiasis. Thời gian phẫu thuật tổng cộng, tỷ lệ thành công trong việc loại bỏ sỏi ống mật chủ (CBD), biến chứng sau phẫu thuật, chuyển đổi sang các thủ tục khác, và thời gian nằm viện đã được đánh giá. Dữ liệu ghép nhóm được đo bằng tỷ số phí (OR) và độ khác biệt trung bình (MD) với khoảng tin cậy 95% (CI). Tám nghiên cứu với tổng cộng 1061 bệnh nhân đã được đưa vào phân tích mét-độ này, bao gồm 542 bệnh nhân nhận LERV và 519 bệnh nhân nhận ERCP + LC. Không có sự khác biệt đáng kể giữa hai nhóm về tỷ lệ thành công trong việc loại bỏ sỏi CBD (OR 2.20, P = 0.10), chảy máu sau phẫu thuật (OR 0.67, P = 0.37), viêm đường mật sau phẫu thuật (OR 0.66, P = 0.53), rò mật sau phẫu thuật (OR 0.87, P = 0.81), hoặc chuyển đổi sang các thủ tục khác (OR 0.75, P = 0.62). Thời gian phẫu thuật tổng cộng ở nhóm LERV lâu hơn (MD = 44.93, P < 0.00001), trong khi LERV liên quan đến ít viêm tụy sau phẫu thuật hơn so với nhóm điều trị hai giai đoạn (OR 0.26, P = 0.0003). Tỷ lệ biến chứng chung thấp hơn ở nhóm LERV so với nhóm điều trị hai giai đoạn (OR 0.41, P < 0.0001), và nhóm LERV có thời gian nằm viện ngắn hơn (MD = − 3.52, P < 0.00001). LERV tương đương với các thủ tục hai giai đoạn truyền thống về mặt loại bỏ sỏi CBD và chuyển đổi, với ít viêm tụy hơn, tỷ lệ biến chứng tổng thể thấp hơn và thời gian nằm viện ngắn hơn, nhưng thời gian phẫu thuật dài hơn. Cần nhiều thử nghiệm lâm sàng hơn để xác định phương pháp điều trị tốt nhất cho bệnh nhân trong các điều kiện khác nhau.

Từ khóa

#cholecystocholedocholithiasis #laparoendoscopic rendezvous #ERCP #laparoscopic cholecystectomy #meta-analysis

Tài liệu tham khảo

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