Laparoscopic transcystic versus transcholedochal common bile duct exploration for choledocholithiasis:a Meta-analysis
10.7659/j.issn.1005-6947.2019.08.002
- VernacularTitle:腹腔镜下经胆囊管胆道探查与腹腔镜下胆总管切开胆道探查治疗胆总管结石的Meta分析
- Author:
Zhangyou GUO
1
;
Can YIN
1
;
Bing TU
1
Author Information
1. 重庆医科大学附属第二医院 肝胆外科/重庆市微创外科中心,重庆 400010
- Publication Type:Journal Article
- Keywords:
Choledocholithiasis;
Laparoscopes;
Common Bile Duct Exploration;
Meta-Analysis
- From:
Chinese Journal of General Surgery
2019;28(8):910-922
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the efficacy,feasibility and safety of laparoscopic transcystic common bile duct exploration(LTCBDE)and laparoscopic common bile duct exploration(LCBDE)in treatment of common bile duct stones.Methods:The relevant studies publicly published from 2009 to 2019 were collected by searching several national and international databases.After literature screening according to the predefined criteria,Meta-analysis was performed by Stata12.0 SE software.Results:A total of 21 studies were finally included,involving 3 804 patients with 1 939 cases in LTCBDE group and 1 865 cases in LCBDE group.The results of Meta-analysis showed that the stone clearance rate in LTCBDE group was significantly higher than that in LCBDE group(OR=1.51,95%CI=1.02-2.25,P=0.038),and the perioperative variables that include intraoperative blood loss(MD=-54.16,95%CI=-101.07--7.26),operative time(MD=-27.27,95%CI=-35.20--19.33),postoperative tube retention time(MD=-1.97,95%CI=-2.32--1.63),length of hospital stay(MD=-3.04,95%CI=-3.58--2.51)and hospitalization cost(MD=-3 554.99,95%CI=-4 209.66--2 900.32)in LTCBDE group were all superior to those in LCBDE group(all P<0.05);the incidence rates of postoperative bile leakage(OR=0.28,95%CI=0.19-0.40),cholangitis(OR=0.33,95%CI=0.14-0.80),biliary stricture(OR=0.32,95%CI=0.11-0.91)and the overall complications(OR=0.33,95%CI=0.25-0.43)in LTCBDE group were all significantly lower than those in LCBDE group(all P<0.05),and no significant differences were noted in the incidence rates of postoperative pancreatitis(OR=0.56,95%CI=0.24-1.32)and biliary tract injury or bleeding(OR=0.64,95%CI=0.24-1.71)between the two groups(both P>0.05).Conclusion:For common bile duct stones,LTCBDE is safer and more effective than LCBDE.So,it is recommended to be used in clinical practice.
