Jiang Cuinan, Zhao Xiuhao, Cheng Shi
Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
JSLS. 2019 Jan-Mar;23(1). doi: 10.4293/JSLS.2018.00077.
Laparoscopic common bile duct exploration (LCBDE) has been verified to be an effective technique in treating choledocholithiasis, and T-tube insertion has been widely performed after LCBDE. With growing doubts regarding the effectiveness and safety of T-tube drainage (TTD), it has been suggested to replace such with primary duct closure (PDC). This meta-analysis aimed to evaluate the short- and long-term effectiveness and safety of PDC compared with TTD after LCBDE.
The PubMed, Science Citation Index, and Cochrane Central Register of Controlled Trials databases were used to accomplish a systematic literature search for randomized controlled trials and pro-/retrospective cohort studies that compared PDC alone or PDC combined with biliary drainage stenting (PDC+BD) with TTD after LCBDE. A subgroup analysis was established to compare PDC+BD with TTD. RevMan 5.3 was used for the statistical analysis.
A total of 2552 patients from 26 studies were included. The pooled odds ratio supported PDC, which yielded lower postoperative overall morbidity and incidence of bile leak and bile peritonitis and shorter surgical time and postoperative hospital stay when compared with TTD. In the subgroup analysis, PDC+BD showed significantly better results in terms of postoperative overall morbidity, incidence of bile leak and bile peritonitis, surgical time, and postoperative hospital stay than did TTD. PDC and PDC+BD showed no difference in the incidence of recurrent stones and biliary stricture during the long-term follow-up period compared with TTD.
PDC alone or PDC+BD is superior to TTD as a duct-closure method after LCBDE.
腹腔镜胆总管探查术（LCBDE）已被证实是治疗胆总管结石的有效技术，LCBDE术后T管置入术已被广泛应用。随着对T管引流（TTD）有效性和安全性的质疑日益增加，有人建议用一期胆管缝合（PDC）取代TTD。本荟萃分析旨在评估LCBDE术后PDC与TTD相比的短期和长期有效性及安全性。
使用PubMed、科学引文索引和Cochrane对照试验中央注册库数据库，对比较LCBDE术后单独PDC或PDC联合胆道引流支架置入术（PDC+BD）与TTD的随机对照试验和前瞻性/回顾性队列研究进行系统文献检索。建立亚组分析以比较PDC+BD与TTD。使用RevMan 5.3进行统计分析。
共纳入26项研究的2552例患者。汇总比值比支持PDC，与TTD相比，PDC术后总体发病率、胆漏和胆汁性腹膜炎发生率更低，手术时间和术后住院时间更短。在亚组分析中，PDC+BD在术后总体发病率、胆漏和胆汁性腹膜炎发生率、手术时间和术后住院时间方面的结果明显优于TTD。与TTD相比，PDC和PDC+BD在长期随访期间结石复发和胆管狭窄发生率方面无差异。
LCBDE术后，单独PDC或PDC+BD作为胆管闭合方法优于TTD。
