Department of the Third Abdominal Surgery, Gansu Province Cancer Hospital, 2 Xiaoxihu East Street, Qilihe, Lanzhou 730050, China.
Department of General Surgery, Second Hospital of Lanzhou University, Lanzhou 730030, China.
Hepatobiliary Pancreat Dis Int. 2018 Jun;17(3):183-191. doi: 10.1016/j.hbpd.2018.03.009. Epub 2018 Mar 24.
Common bile duct (CBD) stones may occur in up to 3%-14.7% of all patients with cholecystectomy. Various approaches of laparoscopic CBD exploration plus primary duct closure (PDC) are the most commonly used and the best methods to treat CBD stone. This systematic review was to compare the effectiveness and safety of the various approaches of laparoscopic CBD exploration plus PDC for choledocholithiasis.
Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) (case-control studies or cohort studies) were searched from Cochrane library (until Issue 2, 2015), Web of Science (1980-January 2016), PubMed (1966-January 2016), and Baidu search engine. After independent quality assessment and data extraction, meta-analysis was conducted using RevMan 5.1 software.
Four RCTs and 18 NRCTs were included. When compared with choledochotomy exploration (CE) plus T-tube drainage (TTD) (CE + TTD), CE plus PDC (CE + PDC) and CE + PDC with biliary drainage (BD) (CE + PDC + BD) had a lower rate of postoperative biliary peritonitis (OR = 0.22; 95% CI: 0.06, 0.88; P < 0.05; OR = 0.27; 95% CI: 0.08, 0.84; P < 0.05; respectively) where T-tubes were removed more than 3 weeks. The operative time of CE + PDC was significantly shorter (WMD = -24.82; 95% CI: -27.48, -22.16; P < 0.01) than that of CE + TTD in RCTs. Cystic duct exploration (CDE) plus PDC (CDE + PDC) has a lower rate of postoperative complications (OR = 0.39; 95% CI: 0.23, 0.67; P < 0.01) when compared with CE + PDC. Confluence part micro-incision exploration (CME) plus PDC (CME + PDC) has a lower rate of postoperative bile leakage (OR = 0.17; 95% CI: 0.04, 0.74; P < 0.05) when compared with CE + PDC.
PDC with other various approaches are better than TTD in the treatment of choledocholithiasis.
胆总管（CBD）结石在所有胆囊切除术患者中的发生率高达 3%-14.7%。腹腔镜 CBD 探查加胆总管一期缝合术（PDC）是治疗 CBD 结石最常用和最好的方法。本系统评价旨在比较腹腔镜 CBD 探查加 PDC 治疗胆总管结石的各种方法的有效性和安全性。
从 Cochrane 图书馆（截至 2015 年第 2 期）、Web of Science（1980 年 1 月至 2016 年 1 月）、PubMed（1966 年 1 月至 2016 年 1 月）和百度搜索引擎中搜索随机对照试验（RCTs）和非随机对照试验（NRCTs）（病例对照研究或队列研究）。经过独立的质量评估和数据提取后，使用 RevMan 5.1 软件进行荟萃分析。
纳入了 4 项 RCTs 和 18 项 NRCTs。与胆总管切开探查加 T 管引流（CE+TTD）相比，CE+PDC 和 CE+PDC 加胆汁引流（CE+PDC+BD）术后胆漏发生率较低（OR=0.22；95%CI：0.06，0.88；P<0.05；OR=0.27；95%CI：0.08，0.84；P<0.05），T 管取出时间超过 3 周。RCTs 中 CE+PDC 的手术时间明显短于 CE+TTD（WMD=-24.82；95%CI：-27.48，-22.16；P<0.01）。与 CE+PDC 相比，胆囊管探查加 PDC（CDE+PDC）术后并发症发生率较低（OR=0.39；95%CI：0.23，0.67；P<0.01）。汇合部微切口探查加 PDC（CME+PDC）术后胆漏发生率较低（OR=0.17；95%CI：0.04，0.74；P<0.05）。
与 TTD 相比，PDC 联合其他各种方法治疗胆总管结石更好。
