Liu Jun-guo, Wang Yi-jun, Shu Gui-ming, Lou Cheng, Zhang Jinjuan, Du Zhi
1 Department of Surgery, Tianjin Third Central Hospital , Tianjin, China .
J Laparoendosc Adv Surg Tech A. 2014 May;24(5):287-94. doi: 10.1089/lap.2013.0546.
To compare the clinical effectiveness of the treatment of choledocholithiasis by laparoscopic common bile duct (CBD) exploration and by endoscopic sphincterotomy (EST).
A meta-analysis of studies about CBD stones was performed to analyze EST in comparison with laparoscopic CBD exploration procedures. Trials were identified by searching the Medline, EMBASE, PubMed, CBM, and CNKI databases from January 1990 to December 2012 for laparoscopic CBD exploration or EST for CBD stones.
Fifteen studies were identified in the meta-analysis. The incidence of bleeding or pancreatitis in the EST group was higher than that in the laparoscopic group. However, the incidence of bile leakage in the EST group was lower than that in the laparoscopic group. The differences in cases of retained stones or total complications were not statistically significant between the laparoscopic and EST groups (P>.05). There were more successful cases in the laparoscopic group than in the EST group (P<.05). Hospital cost was less in the laparoscopic group than in the EST group (P<.05). Mean operation time and hospital stay in the laparoscopic group were shorter than those in the EST group (P<.05).
To some degree, laparoscopic treatment of the CBD may be a better way of removing stones than EST.
比较腹腔镜胆总管探查术与内镜括约肌切开术治疗胆总管结石的临床疗效。
对有关胆总管结石的研究进行荟萃分析，以分析内镜括约肌切开术与腹腔镜胆总管探查术的对比情况。通过检索1990年1月至2012年12月的Medline、EMBASE、PubMed、CBM和CNKI数据库，查找关于腹腔镜胆总管探查术或内镜括约肌切开术治疗胆总管结石的试验。
荟萃分析纳入了15项研究。内镜括约肌切开术组出血或胰腺炎的发生率高于腹腔镜组。然而，内镜括约肌切开术组胆漏的发生率低于腹腔镜组。腹腔镜组与内镜括约肌切开术组在残留结石病例数或总并发症方面的差异无统计学意义（P>0.05）。腹腔镜组的成功病例数多于内镜括约肌切开术组（P<0.05）。腹腔镜组的住院费用低于内镜括约肌切开术组（P<0.05）。腹腔镜组的平均手术时间和住院时间短于内镜括约肌切开术组（P<0.05）。
在某种程度上，腹腔镜治疗胆总管结石可能是比内镜括约肌切开术更好的取石方法。
