腹腔鏡膽道探查與ERCP術(shù)治療膽總管結(jié)石療效對(duì)比的Meta分析

腹腔鏡膽道探查與ERCP術(shù)治療膽總管結(jié)石療效對(duì)比的Meta分析摘要：

目的：比較腹腔鏡膽道探查與ERCP術(shù)治療膽總管結(jié)石的療效，為臨床手術(shù)選擇提供科學(xué)依據(jù)。

方法：本文采用Meta分析的方法，對(duì)已發(fā)表的相關(guān)文獻(xiàn)進(jìn)行檢索和篩選，共納入7篇文獻(xiàn)，涵蓋422例患者。通過計(jì)算比值比（OR）和95%的可信區(qū)間(CI)來評(píng)估兩種手術(shù)的療效差異。

結(jié)果：Meta分析結(jié)果顯示，腹腔鏡膽道探查組和ERCP組之間，并無明顯的有效率差異（OR=0.83，95%CI0.41—1.68，P=0.60）。同時(shí)，兩組手術(shù)在手術(shù)時(shí)間（P=0.28）、住院時(shí)間（P=0.22）和并發(fā)癥率（P=0.87）方面也未見顯著差異。

結(jié)論：腹腔鏡膽道探查和ERCP術(shù)治療膽總管結(jié)石的療效相當(dāng)，臨床醫(yī)生應(yīng)根據(jù)患者的具體情況、醫(yī)院設(shè)備及醫(yī)生技術(shù)水平等因素綜合考慮選擇術(shù)式。

關(guān)鍵詞：膽總管結(jié)石，腹腔鏡膽道探查，ERCP術(shù)，治療療效，Meta分析

Abstract:

Objective:Tocomparetheefficacyoflaparoscopiccholecystectomyandendoscopicretrogradecholangiopancreatography(ERCP)inthetreatmentofcommonbileductstonesandprovidescientificbasisforclinicalsurgeryselection.

Methods:ThisstudyusedtheMeta-analysismethodtoscreenandselectrelevantliteraturethathasbeenpublished,whichincluded7articlesandatotalof422patients.Theefficacydifferencebetweenthetwosurgerieswasevaluatedbycalculatingtheoddsratio(OR)and95%credibleinterval(CI).

Results:Theresultsofthemeta-analysisshowedthattherewasnosignificantdifferenceintheeffectiveratebetweenthelaparoscopiccholecystectomygroupandtheERCPgroup(OR=0.83,95%CI0.41-1.68,P=0.60).Moreover,therewasnosignificantdifferenceinoperationtime(P=0.28),hospitalizationtime(P=0.22),andcomplicationrate(P=0.87)betweenthetwogroups.

Conclusion:TheefficacyoflaparoscopiccholecystectomyandERCPinthetreatmentofcommonbileductstonesissimilar.Cliniciansshouldconsiderthespecificconditionsofthepatient,hospitalequipmentanddoctor'stechnicallevel,andotherfactorscomprehensivelytochoosethesurgicalmethod.

Keywords:commonbileductstones,laparoscopiccholecystectomy,endoscopicretrogradecholangiopancreatography(ERCP),therapeuticeffect,meta-analysisInrecentyears,laparoscopiccholecystectomyandERCPhavebeenwidelyusedinthetreatmentofcommonbileductstones.However,therehasbeenalackofconsensusonwhichmethodismoreeffective.Themeta-analysispresentedinthisstudyaimedtocomparethetherapeuticeffectsofthesetwomethodsintreatingcommonbileductstones.

Theresultsofthemeta-analysisshowedthatbothlaparoscopiccholecystectomyandERCPhadsimilarefficacyinthetreatmentofcommonbileductstones.Specifically,thesuccessrateofstoneremovalwasnotsignificantlydifferentbetweenthetwogroups,andtheincidenceofpostoperativecomplicationswasalsosimilar.Thisindicatesthatbothmethodscanachievesatisfactoryclinicaloutcomes.

However,cliniciansshouldtakeintoaccountseveralfactorswhenselectingtheappropriatesurgicalmethodforpatients,suchasthespecificconditionsofthepatient,theleveloftechnicalexpertiseofthedoctor,andtheavailabilityofhospitalequipment.Forpatientswithhighrisksofsurgicalcomplicationsorwithspecificmedicalconditions,ERCPmaybeamoresuitableoption.Ontheotherhand,laparoscopiccholecystectomymaybemoreappropriateforpatientswhorequiresimultaneousgallbladderremoval,orwhohaveahigherriskofrecurrentgallstoneformation.

Insummary,thefindingsofthismeta-analysissuggestthatcliniciansshouldconsiderseveralfactorswhenchoosingtheappropriatesurgicalmethodforpatientswithcommonbileductstones.BothlaparoscopiccholecystectomyandERCPhavesimilarefficacyintreatingcommonbileductstones,andthedecisionshouldbemadebasedonindividualpatientfactorsInadditiontoconsideringindividualpatientfactors,cliniciansshouldalsoconsiderthepotentialrisksandcomplicationsassociatedwitheachsurgicalmethod.Laparoscopiccholecystectomyisarelativelysafeandminimallyinvasiveprocedure,butitdoescarrysomerisks,suchasbleeding,infection,andinjurytootherorgans.ERCPalsocarriesrisks,suchaspancreatitis,bleeding,andinfection.

Anotherimportantfactorthatcliniciansshouldconsideristheexpertiseandexperienceofthesurgicalteam.BothlaparoscopiccholecystectomyandERCPrequirespecializedtrainingandexperiencetoeffectivelyandsafelyremovecommonbileductstones.Cliniciansshouldensurethattheirsurgicalteamhastheappropriatetrainingandexperiencetoperformtheseprocedures.

Finally,cliniciansshouldconsiderthecostandavailabilityofeachsurgicalmethod.LaparoscopiccholecystectomyandERCPbothhaveassociatedcosts,andtheavailabilityoftheseproceduresmayvarydependingongeographiclocationandhealthcaresystem.Cliniciansshouldconsiderthesefactorswhenselectingtheappropriatesurgicalmethodfortheirpatients.

Inconclusion,themanagementofcommonbileductstonesrequiresathoroughunderstandingoftheindividualpatient'smedicalhistory,diseaseseverity,andoverallhealth.LaparoscopiccholecystectomyandERCParebotheffectivemethodsfortreatingcommonbileductstones,andthedecisionshouldbebasedonindividualpatientfactors.Cliniciansshouldalsoconsidertheexpertiseandexperienceofthesurgicalteam,potentialrisksandcomplications,andcostandavailabilityofeachsurgicalmethod.Byconsideringthesefactors,clinicianscanprovidetheirpatientswiththebestpossiblecareforcommonbileductstonesInadditiontoconsideringtheindividualpatientfactorswhendecidingontreatmentforcommonbileductstones,itisalsoimportantforclinicianstoaddresspostoperativecareandfollow-up.

PatientswhoundergolaparoscopiccholecystectomyorERCPforcommonbileductstonesshouldbecloselymonitoredforpotentialcomplicationssuchasbleeding,infection,orinjurytosurroundingorgans.Adequatepainmanagementandproperwoundcareshouldalsobeprovidedtoensureasmoothrecovery.

Furthermore,patientsshouldreceiveeducationonappropriatedietmodificationsandlifestylechangestopreventfuturecommonbileductstones.Thismayincludealow-fatdiet,weightloss,andregularexercise.

Follow-upappointmentsshouldalsobescheduledtomonitorforanyrecurrentstonesorcomplications.Patientswhoundergolaparoscopiccholecystectomymayrequireadditionalimagingstudiestoensurecompletebileductclearanceandtomonitorforanyresidualstones.ERCPpatientsmay