妊娠期急性胆囊炎：系统评价与荟萃分析。
完整摘要 · 中文译文
背景：急性胆囊炎是妊娠期少见的一种非产科外科急症，但其管理指南仍不一致。本系统综述和荟萃分析考察了被诊断为急性胆囊炎的妊娠患者的表现、诊断、管理和结局。 方法：检索了PubMed、Web of Science和Scopus自建库至2024年2月的文献（PROSPERO CRD42022350290）。符合条件的研究报告了妊娠期急性胆囊炎，并提供了个体患者数据或可提取的队列数据。偏倚风险由两人重复评估。描述性统计汇总个体数据，随机效应荟萃分析生成合并风险比（RR）及95%置信区间（CI）。 结果：共纳入90项研究（1964-2023年）：48项病例报告/系列（n = 118），19项描述性队列（n = 5,702），19项比较手术与非手术治疗的队列（n = 91,955），以及4项比较腹腔镜与开腹手术的队列（n = 62,620）。在有症状数据的病例中（n = 75），以右上腹疼痛（40%）、呕吐（33%）、恶心（29%）和发热（17%）为主。影像学检查（n = 92）最常显示胆结石（42%）和超声显示的胆囊炎或壁增厚（21%）。在有管理数据的病例中（n = 93），81例接受了手术（腹腔镜71/81；经皮引流10/81；开腹1/81）；12例接受了非手术治疗。在有结局的83例中，84%病程无并发症。荟萃分析发现，手术与非手术治疗在剖宫产、早产、产后出血方面无显著差异 出血或复合并发症，但手术组的静脉血栓栓塞风险较低（RR 0.55，95% CI 0.37-0.82），尽管该结局仅由两项研究报告。 结论：基于超声的诊断和腹腔镜胆囊切除术在整个妊娠各孕期似乎是安全的，产科结局与非手术治疗相当。手术治疗与观察到的静脉血栓栓塞风险较低相关，尽管该发现基于有限的证据。需要进一步的前瞻性研究以优化患者选择和安全手术时机。
完整摘要 · 英文原文
BACKGROUND: Acute cholecystitis is an uncommon non-obstetric surgical emergency in pregnancy, yet guidance on management remains inconsistent. This systematic review and meta-analysis examined presentation, diagnostics, management, and outcomes of pregnant patients diagnosed with acute cholecystitis. METHODS: PubMed, Web of Science, and Scopus were searched from inception to February 2024 (PROSPERO CRD42022350290). Eligible studies reported acute cholecystitis in pregnancy with individual patient data or extractable cohort data. Risk of bias was assessed in duplicates. Descriptive statistics summarised individual data, and random-effects meta-analysis generated pooled risk ratios (RR) with 95% confidence interval (CI). RESULTS: Ninety studies (1964-2023) were included: 48 case reports/series (n = 118), 19 descriptive cohorts (n = 5,702), 19 cohorts comparing operative versus non-operative care (n = 91,955), and 4 cohorts comparing laparoscopic versus open surgery (n = 62,620). Among cases with symptom data (n = 75), right-upper-quadrant pain (40%), vomiting (33%), nausea (29%), and fever (17%) predominated. Imaging (n = 92) most often showed gallstones (42%) and ultrasonographic cholecystitis or wall thickening (21%). Of the cases with management data (n = 93), surgery was performed in 81 (laparoscopic 71/81; percutaneous drainage 10/81; open 1/81);12 were managed non-operatively. Of 83 with outcomes, 84% had uncomplicated courses. Meta-analysis found no significant differences between operative and non-operative care for caesarean delivery, preterm birth, postpartum haemorrhage, or composite complications, but venous thromboembolism risk was lower with surgery (RR 0.55, 95% CI 0.37-0.82), although this outcome was reported by only two studies. CONCLUSIONS: Ultrasound-based diagnosis and laparoscopic cholecystectomy appear safe across all trimesters of pregnancy, with obstetric outcomes comparable to non-operative management. Operative management was associated with a lower observed risk of venous thromboembolism, although this finding was based on limited evidence. Further prospective studies are needed to optimise patient selection and surgical timing.