背景:科学文献中关于腹腔镜与开腹胆囊切除术结果的相互矛盾的证据影响了胆囊疾病患者的医疗决策。这项研究旨在比较接受腹腔镜胆囊切除术的患者和接受开腹手术的患者之间的主要和次要结果。方法利用PubMedCentral/Medline的高级过滤器,探索1993年至2023年发表的文章,WebofScience,CINAHL,JSTOR,科克伦图书馆,Scopus,和EBSCO。通过存在以下一种或多种情况来确定胆囊疾病:1)坏疽性胆囊炎,2)急性胆囊炎,3)慢性胆囊疾病,和4)胆石症。主要终点是死亡率,而次要结果包括(1)胆漏,2)胆总管损伤,3)坏疽,4)住院时间(天),5)主要并发症,6)中位住院时间(天),(7)肺炎,8)病叶(天),和9)伤口感染。结果观察到死亡率的统计学显着降低(比值比[OR]:0.30,95%置信区间[CI]:0.30,0.45,p<0.00001),平均住院时间(平均差异:-2.68,95%CI:-3.66,-1.70,p<0.00001),主要并发症(OR:0.35,95%CI:0.19,0.64,p=0.0005),术后/术中伤口感染(OR:0.29,95%CI:0.16,0.51,p<0.0001),和病叶(OR:0.34,95%CI:0.14,0.80,p=0.01)在接受腹腔镜胆囊切除术的患者中。胆漏研究组之间无统计学差异,胆总管损伤,坏疽,住院天数中位数,和肺炎(p>0.05)。结论合并的结果有利于胆囊疾病患者使用腹腔镜胆囊切除术而不是开腹手术。综合研究结果表明,腹腔镜胆囊切除术对改善患者预后的影响更大。包括安全事件,与开腹胆囊切除术相比。
Background Conflicting evidence regarding the laparoscopic versus open cholecystectomy outcomes in scientific literature impacts the medical decision-making for patients with gallbladder disease. This study aimed to compare a range of primary and secondary outcomes between patients receiving laparoscopic cholecystectomy and those with open intervention. Methods Articles published from 1993 to 2023 were explored by utilizing advanced filters of PubMed Central/Medline, Web of Science, CINAHL, JSTOR, Cochrane Library, Scopus, and EBSCO. The gallbladder disease was determined by the presence of one or more of the following conditions: 1) Gangrenous cholecystitis, 2) acute cholecystitis, 3) chronic gallbladder diseases, and 4) cholelithiasis. The primary end-point was mortality, while the secondary outcome included (1) bile leakage, 2) common bile duct injury, 3) gangrene, 4) hospital stay (days), 5) major complications, 6) median hospital stay (days), (7) pneumonia, 8) sick leaves (days), and 9) wound infection. Results Statistically significant reductions were observed in mortality (odds ratio [OR]: 0.30, 95% confidence interval [CI]: 0.30, 0.45, p < 0.00001), mean hospital stay duration (mean difference: -2.68, 95% CI: -3.66, -1.70, p < 0.00001), major complications (OR: 0.35, 95% CI: 0.19, 0.64, p = 0.0005), post/intraoperative wound infection (OR: 0.29, 95% CI: 0.16, 0.51, p < 0.0001), and sick leaves (OR: 0.34, 95% CI: 0.14, 0.80, p = 0.01) in patients who underwent laparoscopic cholecystectomy compared with those with the open intervention. No statistically significant differences were recorded between the study groups for bile leakage, common bile duct injury, gangrene, median hospital stay days, and pneumonia ( p > 0.05). Conclusions The pooled outcomes favored the use of laparoscopic cholecystectomy over the open procedure in patients with gallbladder disease. The consolidated findings indicate the higher impact of laparoscopic cholecystectomy in improving patient outcomes, including safety episodes, compared with open cholecystectomy.