切换至 "中华医学电子期刊资源库"
高级检索
中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2023, Vol. 12 ›› Issue (02) : 201 -205. doi: 10.3877/cma.j.issn.2095-3232.2023.02.015

所属专题： 临床研究；

临床研究

一期与二期经皮经肝胆道镜取石术治疗中国肝内胆管结石患者安全性与疗效比较Meta分析
涂建华1, 史亚波1, 李杨1, 刘华兵2, 黄长文3, 饶雪峰3,†()   
  1. 1. 330036　南昌大学医学院；330006　南昌，江西省人民医院（南昌医学院第一附属医院）肝胆外科
    2. 330036　南昌大学医学院；330006　南昌，江西省人民医院（南昌医学院第一附属医院）胃肠外科
    3. 330006　南昌，江西省人民医院（南昌医学院第一附属医院）肝胆外科
  • 收稿日期:2022-11-17 出版日期:2023-03-28
  • 通信作者: 饶雪峰
  • 基金资助:
    江西省自然科学基金资助面上项目(20202BABL206096)

Comparison of safety and efficacy of one-stage and two-stage percutaneous transhepatic cholangioscopic lithotomy for patients with hepatolithiasis in China: a Meta-analysis

Jianhua Tu1, Yabo Shi1, Yang Li1, Huabin Liu2, Changwen Huang3, Xuefeng Rao3,†()   

  1. 1. Medical College of Nanchang University, Nanchang 330036, China; Department of Hepatobiliary Surgery, Jiangxi Provincial People's Hospital (the First Affiliated Hospital of Nanchang Medical College), Nanchang 330006, China
    2. Medical College of Nanchang University, Nanchang 330036, China; Department of Gastrointestinal Surgery, Jiangxi Provincial People's Hospital (the First Affiliated Hospital of Nanchang Medical College), Nanchang 330006, China
    3. Department of Hepatobiliary Surgery, Jiangxi Provincial People's Hospital (the First Affiliated Hospital of Nanchang Medical College), Nanchang 330006, China
  • Received:2022-11-17 Published:2023-03-28
  • Corresponding author: Xuefeng Rao
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

涂建华, 史亚波, 李杨, 刘华兵, 黄长文, 饶雪峰. 一期与二期经皮经肝胆道镜取石术治疗中国肝内胆管结石患者安全性与疗效比较Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(02): 201-205.

Jianhua Tu, Yabo Shi, Yang Li, Huabin Liu, Changwen Huang, Xuefeng Rao. Comparison of safety and efficacy of one-stage and two-stage percutaneous transhepatic cholangioscopic lithotomy for patients with hepatolithiasis in China: a Meta-analysis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(02): 201-205.

目的

系统评价和比较一期与二期经皮经肝胆道镜取石术（PTCSL）治疗我国肝内胆管结石的安全性和有效性。

方法

计算机检索中国知网、万方、维普、Embase、PubMed和Cochrane Library数据库中关于一期与二期PTCSL治疗中国肝内胆管结石患者的对照研究，年限为2012年1月至2022年1月。检索语种为中文和英文。主要中文检索词为：肝内胆管结石，肝胆管结石，一期，二期，经皮经肝胆道镜。主要英文检索词为：hepatolithiasis，one stage，second stage，percutaneous hepatocholangioscopy。由两名研究者独立检索、筛选文献并提取资料信息后，采用RevMan 5.4软件进行Meta分析。

结果

共纳入符合标准的文献8篇，其中随机对照试验研究3篇，队列研究5篇，总样本量748例，一期组350例，二期组398例。Meta分析结果显示，一期与二期PTCSL治疗肝内胆管结石在手术时间、术中出血量（MD=0.20，0.97；P>0.05），结石清除率、术后总并发症发生率（RR=1.04，1.31；P>0.05）方面比较差异无统计学意义。一期组患者的住院时间明显短于二期组（MD=-2.36，P<0.05），但一期组术后胆道出血发生率明显高于二期组（RR=1.79，P<0.05）。

结论

与一期PTCSL相比，二期PTCSL治疗中国肝内胆管结石患者的住院时间较长，但术后胆道出血发生率较低。

关键词: 胆结石, 经皮经肝胆道镜取石术, Meta分析
Objective

To systematically evaluate and compare the efficacy and safety of one-stage and two-stage percutaneous transhepatic cholangioscopic lithotomy (PTCSL) in the treatment of patients with hepatolithiasis in China.

Methods

Controlled trials related to one-stage or two-stage PTCSL in the treatment of hepatolithiasis in China published between January 2012 and January 2022 were searched in CNKI, Wanfang Data, Chongqing VIP, Embase, PubMed and Cochrane Library in both Chinese and English. The searching terms mainly consisted of hepatolithiasis, one stage, second stage and percutaneous hepatocholangioscopy. Literature searching, literature screening and information extraction were performed by two independent researchers. RevMan 5.4 software was used for Meta-analysis.

Results

8 eligible articles were included, including 3 randomized controlled trials and 5 cohort studies, with a total sample size of 748 cases, 350 cases in one stage group and 398 cases in two stage group. Meta-analysis showed that no significant difference was observed in the operation time and intraoperative blood loss (MD=0.20, 0.97; P>0.05), the stone clearance rate and the incidence of total postoperative complications (RR=1.04, 1.31; P>0.05) between the one-stage and two-stage PTCSL for hepatolithiasis. The length of hospital stay of patients in the one-stage group was significantly shorter than that in the two-stage group (MD=-2.36, P<0.05), whereas the incidence of postoperative biliary bleeding in the one-stage group was significantly higher than that in the two-stage group (RR=1.79, P<0.05).

Conclusions

Compared with one-stage PTCSL, two-stage PTCSL requires longer length of hospital stay, whereas yields lower incidence of postoperative biliary bleeding in treating patients with hepatolithiasis in China.

Key words: Cholelithiasis, Percutaneous transhepatic cholangiography lithotomy, Meta-analysis
表1 纳入文献的一般特征及质量评价
作者 发表年份 样本量（例） 性别（例，男/女） 年龄（岁，±s） 文献质量
一期组 二期组 一期组 二期组 一期组 二期组
徐兵等[7] 2021 44 44 21/23 20/24 48.5±10.3 48.2±10.2 B级a
刘懿等[10] 2020 40 74 18/22 34/40 49.4±10.7 48.6±10.4 6分b
陈武业等[11] 2019 38 52 - - - - 7分b
李志等[12] 2018 22 35 9/13 13/22 48.7±14.6 49.6±13.7 7分b
Wang等[13] 2016 67 51 33/34 24/27 55.2±13.5 58.8±16.5 8分b
周明等[14] 2016 50 50 42/58 35.2±5.9 6分b
刘晓洋等[8] 2015 50 50 1/29 21/29 53.4±2.5 56.3±4.3 B级a
王平等[9] 2014 39 42 13/26 15/27 51.3±4.0 52.5±3.2 B级a
图1 一期与二期PTCSL治疗中国肝内胆管结石患者住院时间比较Meta分析森林图注：PTCSL为经皮经肝胆道镜取石术
图2 一期与二期PTCSL治疗中国肝内胆管结石患者术后胆道出血比较Meta分析森林图注：PTCSL为经皮经肝胆道镜取石术
[1]
Lorio E, Patel P, Rosenkranz L, et al. Management of hepatolithiasis: review of the literature[J]. Curr Gastroenterol Rep, 2020, 22(6):30.
[2]
王苑, 许洪伟. 我国胆石症危险因素的Meta分析[J]. 中华肝胆外科杂志, 2016, 22(6):386-390.
[3]
Kim HJ, Kim JS, Joo MK, et al. Hepatolithiasis and intrahepatic cholangiocarcinoma: a review[J]. World J Gastroenterol, 2015, 21(48):13418-13431.
[4]
Blechacz B, Komuta M, Roskams T, et al. Clinical diagnosis and staging of cholangiocarcinoma[J]. Nat Rev Gastroenterol Hepatol, 2011, 8(9):512-522.
[5]
梁力建. "解除梗阻、去除病灶、通畅引流"至今仍是治疗肝胆管结石病的基本原则[J]. 中华消化外科杂志, 2016, 15(4):316-318.
[6]
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9):603-605.
[7]
徐兵, 陈智年, 闫东红, 等. 一期经皮肝胆道镜碎石术治疗肝胆管结石的效果及安全性[J]. 临床医学工程, 2021, 28(12):1617-1618.
[8]
刘晓洋, 刘晓明, 智绪亭. 两种不同PTCSL路径治疗肝胆管结石的临床效果比较[J]. 中国现代普通外科进展, 2015, 18(7):530-532.
[9]
王平, 方兆山, 孙北望, 等. 经皮肝胆道硬镜碎石治疗肝胆管结石手术路径选择的临床研究[J]. 实用医学杂志, 2014, 30(20): 3245-3248.
[10]
刘懿, 刘韬, 冯静刚. 一期或二期经皮经肝胆道镜碎石取石术治疗肝内胆管结石的疗效比较[J]. 安徽医药, 2020, 24(11):2245-2247.
[11]
陈武业, 方永平, 李坤平, 等. 经皮经肝穿刺一期硬质胆道镜取石术治疗肝内胆管结石的疗效分析[J]. 中华普通外科杂志, 2019, 34(1):68-69.
[12]
李志, 张剑权, 符国珍, 等. 超声引导经皮经肝一期胆道镜碎石取石术治疗肝内胆管结石[J]. 中华肝胆外科杂志, 2018, 24(3): 208-210.
[13]
Wang P, Sun B, Huang B, et al. Comparison between percutaneous transhepatic rigid cholangioscopic lithotripsy and conventional percutaneous transhepatic cholangioscopic surgery for hepatolithiasis treatment[J]. Surg Laparosc Endosc Percutan Tech，2016, 26(1):54-59.
[14]
周明, 陶健, 胡明泰. 肝胆管结石患者经皮肝胆道镜碎石治疗的临床效果探讨[J]. 结直肠肛门外科, 2016，22(S1):81.
[15]
Dilek ON, Atasever A, Acar N, et al. Hepatolithiasis: clinical series, review and current management strategy[J]. Turk J Surg, 2020, 36(4):382-392.
[16]
Das BC, Rahman MM, Biswas AK, et al. Surgical treatment of hepatolithiasis: our experience in Bangabandhu Sheikh Mujib Medical University[J]. Mymensingh Med J, 2017, 26(4):797-804
[17]
Kim HJ, Kang TU, Swan H, et al. Incidence and prognosis of subsequent cholangiocarcinoma in patients with hepatic resection for bile duct stones[J]. Dig Dis Sci, 2018, 63(12):3465-3473.
[18]
潘树波, 吴春利, 侯辉, 等. 基于倾向性评分匹配的开腹和腹腔镜肝切除术治疗肝左叶胆管结石的队列研究[J]. 中华外科杂志, 2020, 58(7):530-538.
[19]
Nezami N, Benchetrit L, Latich I, et al. Cholangiolithiasis postliver transplantation: successful treatment utilizing percutaneous transhepatic cholangioscopy and laser lithotripsy[J]. Radiol Case Rep, 2019, 14(12):1459-1466.
[20]
Lamanna A, Maingard J, Bates D, et al. Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis: a technical report[J].J Med Imaging Radiat Oncol, 2019, 63(6):758-764.
[21]
Zhang Z, Liu Z, Liu L, et al. Strategies of minimally invasive treatment for intrahepatic and extrahepatic bile duct stones[J]. Front Med, 2017, 11(4):576-589.
[22]
Tao H, Wang P, Sun B, et al. One-step percutaneous transhepatic cholangioscopy combined with high-frequency needle-knife electrotomy in biliary strictures after liver transplantation[J]. Surg Laparosc Endosc Percutan Tech, 2021, 31(6):787-793.
[23]
Shen H, Zhang S, Xia Y, et al. A nomogram in predicting risks of intrahepatic cholangiocarcinoma after partial hepatectomy for hepatolithiasis[J]. J Gastrointest Surg, 2021, 25(9):2258-2267.
[24]
Miura F, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis[J]. J Hepatobiliary Pancreat Sci, 2018, 25(1):31-40.
[25]
Sokal A, Sauvanet A, Fantin B, et al. Acute cholangitis: diagnosis and management[J]. J Visc Surg, 2019, 156(6):515-525.
[1] 张思平, 刘伟, 马鹏程. 全膝关节置换术后下肢轻度内翻对线对疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(06): 808-817.
[2] 罗旺林, 杨传军, 许国星, 俞建国, 孙伟东, 颜文娟, 冯志. 开放性楔形胫骨高位截骨术不同植入材料的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(06): 818-826.
[3] 马鹏程, 刘伟, 张思平. 股骨髋臼撞击综合征关节镜手术中闭合关节囊的疗效影响[J]. 中华关节外科杂志(电子版), 2023, 17(05): 653-662.
[4] 陈宏兴, 张立军, 张勇, 李虎, 周驰, 凡一诺. 膝骨关节炎关节镜清理术后中药外用疗效的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(05): 663-672.
[5] 邢阳, 何爱珊, 康焱, 杨子波, 孟繁钢, 邬培慧. 前交叉韧带单束联合前外侧结构重建的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(04): 508-519.
[6] 尹朱丹, 王昱, 镇坷, 许彬, 田雅丽, 童孜蓉. 早期低热量肠内营养对危重症患者预后影响的Meta分析[J]. 中华危重症医学杂志(电子版), 2023, 16(03): 215-222.
[7] 李雄雄, 周灿, 徐婷, 任予, 尚进. 初诊导管原位癌伴微浸润腋窝淋巴结转移率的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 466-474.
[8] 张再博, 王冰雨, 焦志凯, 檀碧波. 胃癌术后下肢深静脉血栓危险因素的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 475-480.
[9] 武慧铭, 郭仁凯, 李辉宇. 机器人辅助下经自然腔道取标本手术治疗结直肠癌安全性和有效性的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(05): 395-400.
[10] 莫闲, 杨闯. 肝硬化患者并发门静脉血栓危险因素的Meta分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 678-683.
[11] 刘佳铭, 孙晓容, 文健, 何晓丽, 任茂玲. 有氧运动对成人哮喘肺功能、生活质量以及哮喘控制影响的Meta分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 592-595.
[12] 段文忠, 白延霞, 徐文亭, 祁虹霞, 吕志坚. 七氟烷和丙泊酚在肝切除术中麻醉效果比较Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 640-645.
[13] 杨海龙, 邓满军, 樊羿辰, 徐梦钰, 陈芳德, 吴威浩, 张生元. 腹腔镜胆总管探查术一期缝合术后胆漏危险因素Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 545-550.
[14] 徐红莉, 杨钰琳, 薛清, 张茜, 马丽虹, 邱振刚. 体外冲击波治疗非特异性腰痛疗效的系统评价和Meta分析[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 307-314.
[15] 苏慧媛, 宋洪涛, 高巍, 武忠. 针刺治疗单纯性肥胖的系统评价和Meta分析[J]. 中华针灸电子杂志, 2023, 12(03): 123-128.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号