背景:数十年的争论围绕胆囊切除术中使用术中胆道造影(IOC)。到现在,在降低胆管损伤率(BDI)方面,IOC的作用存在争议.我们旨在回顾和分析有关IOC在胆囊切除术中的益处的现有文献。
方法:在2020年10月19日之前,在五个数据库中进行了系统的文献检索,使用以下检索键:胆管和胆囊切除术。主要结果是BDI和保留结石率。调查组间差异(常规IOCvs选择性IOC和IOCvs无IOC),我们计算了连续结局的加权平均差(WMD)和二分结局的相对风险(RR),95%置信区间(CI)。
结果:在19,863篇文章中,在定量合成中选择38个和32个。与选择性IOC相比,常规IOC在降低BDI方面没有优势(RR=0.91,95%CI0.66;1.24)。比较国际奥委会和没有国际奥委会,在BDI的情况下没有发现统计学上的显着差异,保留石率,再入院率,和住院时间。我们发现非IOC组患者接受开放手术的转化率增加(RR=0.64,CI0.51;0.78)。与无IOC组相比,IOC组的手术时间明显更长(WMD=11.25分钟,95%CI6.57;15.93)。
结论:我们的研究结果表明,并非在每种情况下都可以使用IOC,然而,证据非常不确定。需要进一步高质量的研究来解决这个问题。
Decades of debate surround the use of intraoperative cholangiography (
IOC) during cholecystectomy. To the present day, the role of IOC is controversial as regards decreasing the rate of bile duct injury (BDI). We aimed to review and analyse the available literature on the benefits of IOC during cholecystectomy.
A systematic literature search was performed until 19 October 2020 in five databases using the following search keys: cholangiogra* and cholecystectomy. The primary outcomes were BDI and retained stone rate. To investigate the differences between the groups (routine
IOC vs selective
IOC and
IOC vs no
IOC), we calculated weighted mean differences (WMD) for continuous outcomes and relative risks (RR) for dichotomous outcomes, with 95% confidence intervals (CI).
Of the 19,863 articles, 38 were selected and 32 were included in the quantitative synthesis. Routine
IOC showed no superiority compared to selective
IOC in decreasing BDI (RR = 0.91, 95% CI 0.66; 1.24). Comparing
IOC and no
IOC, no statistically significant differences were found in the case of BDI, retained stone rate, readmission rate, and length of hospital stay. We found an increased risk of conversion rate to open surgery in the no IOC group (RR = 0.64, CI 0.51; 0.78). The operation time was significantly longer in the
IOC group compared to the no
IOC group (WMD = 11.25 min, 95% CI 6.57; 15.93).
Our findings suggest that IOC may not be indicated in every case, however, the evidence is very uncertain. Further good quality research is required to address this question.