Application Of Percutaneous Transhepatic Gallbladder Drainage Combined With Laparoscopic Cholecystectomy For Elderly Patients With Acute Cholecystitis: A Meta-analysis

Objective:To systematically evaluate the effectiveness and safety of percutaneo us transhepatic gallbladder drainage(PTGD)combined with laparoscopic chole cystectomy( LC) for elderly patients with acute cholecystitis.Methods:The databases such as Pub Med、EMBASE、Cochrane Library and C BM、CNKI、CJFD、Wan Fang Data were searched to collect randomized contr olled trials(RCTs) and Non-randomized controlled trials(NRCTs) from 2000 t o1,2016. The literatures were limited in Chinese and English.The studies scree ned, data extracted and the methodological quality assessed were finished by two reviewers independently. Meta-analyses were conducted by using Rev Ma n 5.3 soft ware.Results:A total of 15 controlled trials(1248 patients)included. The results: the operation time:MD=-26.26,95%CI=[-35.06,-17.45],Z=5.84,P<0.00001.Blood loss:MD=-47.00,95%CI=[-53.70,-40.30],Z=13.75,P<0.00001.Hospitalization time after operation:MD=-2.47,95%CI=[-3.74,-1.20],Z=3.81,P=0.0001.The rates of laparosco pic cholecystectomy(LC) conversion to Laparotomy: OR=0.43,95%CI=[0.29,0.64],Z=4.19,P<0.0001.The rates of postoperation complication: OR=0.20,95%CI=[0.13,0.30],Z=7.67,P<0.00001.The rates of postoperation Patients with peritonea l drainage pipes: OR=0.20,95%CI=[0.10,0.41],Z=4.45,P<0.00001.The time of dra inage : MD=-1.30, 95%CI=[-1.87,-0.73],Z=4.47,P<0.00001.Postoperative exhaus t time for the first time;MD=-1.48,95%CI=[-2.08,-0.88],Z=4.84,P<0.00001. Th e meta-analysis all showed statistically significant.Conclusion:Compared the emergency laparoscopic cholecystectomy,PTGD+LC can reduce the operation time,postoperative time of intestinal function recover y, The time of drainage and hospitalization days. PTGD+LC can also lower t he rate of LC conversion to Laparotomy, postoperation complication and posto perative patients with peritoneal drainage pipes.