Efficacy of laparoscopic choledochoscopy combined with holmium laser lithotripsy versus traditional laparotomy in treatment of bile duct stones： A Meta－analysis
10.3969/j.issn.1001-5256.2023.10.021
- VernacularTitle:腹腔镜下胆道镜联合钬激光碎石术与传统开腹手术治疗胆管结石效果比较的Meta分析
- Author:
Xiangdong NIU
1
;
Jing YU
2
;
Xuyun WANG
1
;
Yifeng CHEN
1
;
Shixun MA
1
;
Guogan DING
1
;
Changfeng MIAO
1
;
Xiaopeng WANG
1
;
He SU
1
Author Information
1. Department of General Surgery, Gansu Provincial Hospital， Lanzhou 730030， China
2. Department of Geriatric Medicine， Gansu Provincial Hospital， Lanzhou 730030， China， Lanzhou 730030， China
- Publication Type:Journal Article
- Keywords:
Gallstones;
Laparoscopy;
Lasers， Solid－State;
Treatment Outcome;
Meta－Analysis
- From:
Journal of Clinical Hepatology
2023;39(10):2421-2431
- CountryChina
- Language:Chinese
-
Abstract:
ObjectiveTo systematically review the efficacy and safety of laparoscopic choledochoscopy combined with holmium laser lithotripsy through a meta－analysis. MethodsThis study was conducted based on PRISMA guidelines， with a PROSPERO registration number of CRD42023406221. Chinese databases including CNKI， Wanfang Data， and VIP and foreign language databases such as PubMed， Embase， the Cochrane Library， and Web of Science were searched for original articles on traditional laparotomy versus laparoscopic choledochoscopy combined with holmium laser lithotripsy in the treatment of bile duct stones. Dichotomous variables were assessed by odds ratio （OR） and 95% confidence interval （CI）， while continuous variables were assessed by weighted mean difference （WMD） and 95%CI， and a sensitivity analysis was performed for outcome measures with relatively high heterogeneity. The Begg test and Egger test were used to evaluate publication bias. Stata 15.0 and Review Manager 5.3 were used to perform the statistical analysis. ResultsA total of 26 retrospective studies from China were included in this study， with 2 238 patients in total. The meta－analysis showed that compared with traditional laparotomy for the treatment of bile duct stones， laparoscopic choledochoscopy combined with holmium laser lithotripsy had significantly shorter time of operation （WMD＝－1.26， 95%CI： －1.36 to －1.16， P<0.001）， length of hospital stay （WMD＝－1.93， 95%CI： －2.64 to －1.12， P <0.001）， and time to bowel function recovery （WMD＝－1.52， 95%CI： －1.68 to －1.35， P<0.001）， significantly less intraoperative blood loss （WMD＝－1.79， 95%CI： －1.93 to －1.66， P<0.001）， a significantly lower rate of intraoperative residual stone （OR＝0.15， 95%CI： 0.11－0.20， P<0.001）， and significantly fewer complications （OR＝0.17， 95%CI： 0.13－0.23， P<0.001）. ConclusionCompared with traditional laparotomy， laparoscopic choledochoscopy combined with holmium laser lithotripsy shows better efficacy in the treatment of bile duct stones.
