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JAMA Surg：4种胆结石手术方案效果及安全性比较

2018-06-06 zhangfan MedSci原创

胆结石腹腔镜胆囊切除术胰胆管造影
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研究认为腹腔镜胆囊切除术联合术中内镜逆行胰胆管造影是最为安全有效的胆石症合并胆管结石治疗方法

手术治疗胆石症合并胆管结石的方法很多，近日研究人员就常见的4种手术方法的疗效和安全性进行了比较。

本次研究为系统综述及荟萃风险研究，收集1950-2017年间的相关资料。入选的临床研究含有以下策略：术前内镜逆行胰胆管造影(PreERCP)+ 腹腔镜胆囊切除术（LC）、LC+腹腔镜胆总管探查(LCDBE)、LC+术中内镜逆行胰胆管造影(IntraERCP)以及LC+术后ERCP (PostERCP)。研究的主要终点为手术安全性及效果，次要终点包括急性胰腺炎、胆漏、出血、手术时间、住院时间、总费用和二次入院率，以累积排序曲线下面积进行评估（SUCRA）。

总计20个研究纳入本次荟萃分析，包含2489名患者，进行了2489次手术。研究发现LC+ IntraERCP其手术成功率 (SUCRA， 87.2%)及安全性(SUCRA， 69.7%)最高。4种方法患者死亡风险相近，但LC+ LCBDE的总出血风险最低(SUCRA， 83.3%)、手术时间最短(SUCRA， 90.2%)并且花费最少(SUCRA， 98.9%)，减少急性胰腺炎风险，但与胆漏风险增加有关。LC+ IntraERCP住院时间最短(SUCRA， 92.7%)。

研究认为腹腔镜胆囊切除术联合术中内镜逆行胰胆管造影是最为安全有效的胆石症合并胆管结石治疗方法。

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    2018-06-09 12282355m97暂无昵称

    学习了

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=322783, encodeId=cfba322e83df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0af42337291, createdName=12282355m97暂无昵称, createdTime=Sat Jun 09 11:03:10 CST 2018, time=2018-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322591, encodeId=e6a5322591eb, content=学习了.赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0af42337291, createdName=12282355m97暂无昵称, createdTime=Fri Jun 08 21:03:45 CST 2018, time=2018-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322050, encodeId=774d3220502a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160724/IMG5794947965DD66089.jpg, createdBy=fa631714605, createdName=如草, createdTime=Wed Jun 06 23:05:15 CST 2018, time=2018-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321952, encodeId=bdd6321952a1, content=有学习了最新科研成果.谢谢谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aadd1680584, createdName=蔬菜, createdTime=Wed Jun 06 14:43:57 CST 2018, time=2018-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321942, encodeId=c31a3219420e, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Jun 06 13:48:35 CST 2018, time=2018-06-06, status=1, ipAttribution=)]
    2018-06-08 12282355m97暂无昵称

    学习了.赞

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=322783, encodeId=cfba322e83df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0af42337291, createdName=12282355m97暂无昵称, createdTime=Sat Jun 09 11:03:10 CST 2018, time=2018-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322591, encodeId=e6a5322591eb, content=学习了.赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0af42337291, createdName=12282355m97暂无昵称, createdTime=Fri Jun 08 21:03:45 CST 2018, time=2018-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322050, encodeId=774d3220502a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160724/IMG5794947965DD66089.jpg, createdBy=fa631714605, createdName=如草, createdTime=Wed Jun 06 23:05:15 CST 2018, time=2018-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321952, encodeId=bdd6321952a1, content=有学习了最新科研成果.谢谢谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aadd1680584, createdName=蔬菜, createdTime=Wed Jun 06 14:43:57 CST 2018, time=2018-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321942, encodeId=c31a3219420e, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Jun 06 13:48:35 CST 2018, time=2018-06-06, status=1, ipAttribution=)]
    2018-06-06 如草

    学习了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=322783, encodeId=cfba322e83df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0af42337291, createdName=12282355m97暂无昵称, createdTime=Sat Jun 09 11:03:10 CST 2018, time=2018-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322591, encodeId=e6a5322591eb, content=学习了.赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0af42337291, createdName=12282355m97暂无昵称, createdTime=Fri Jun 08 21:03:45 CST 2018, time=2018-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322050, encodeId=774d3220502a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160724/IMG5794947965DD66089.jpg, createdBy=fa631714605, createdName=如草, createdTime=Wed Jun 06 23:05:15 CST 2018, time=2018-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321952, encodeId=bdd6321952a1, content=有学习了最新科研成果.谢谢谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aadd1680584, createdName=蔬菜, createdTime=Wed Jun 06 14:43:57 CST 2018, time=2018-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321942, encodeId=c31a3219420e, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Jun 06 13:48:35 CST 2018, time=2018-06-06, status=1, ipAttribution=)]
    2018-06-06 蔬菜

    有学习了最新科研成果.谢谢谢谢分享!

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=322783, encodeId=cfba322e83df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0af42337291, createdName=12282355m97暂无昵称, createdTime=Sat Jun 09 11:03:10 CST 2018, time=2018-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322591, encodeId=e6a5322591eb, content=学习了.赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0af42337291, createdName=12282355m97暂无昵称, createdTime=Fri Jun 08 21:03:45 CST 2018, time=2018-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322050, encodeId=774d3220502a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160724/IMG5794947965DD66089.jpg, createdBy=fa631714605, createdName=如草, createdTime=Wed Jun 06 23:05:15 CST 2018, time=2018-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321952, encodeId=bdd6321952a1, content=有学习了最新科研成果.谢谢谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aadd1680584, createdName=蔬菜, createdTime=Wed Jun 06 14:43:57 CST 2018, time=2018-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321942, encodeId=c31a3219420e, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Wed Jun 06 13:48:35 CST 2018, time=2018-06-06, status=1, ipAttribution=)]
    2018-06-06 明月清辉

    谢谢分享.学习了

    0

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