Department of General Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi Province, China.
Surg Endosc. 2020 Apr;34(4):1522-1533. doi: 10.1007/s00464-020-07394-x. Epub 2020 Feb 3.
Laparoscopic common bile duct exploration (LCBDE) has been becoming more and more popular in patients with symptomatic choledocholithiasis. However, the safety and effectiveness of LCBDE in elderly patients with choledocholithiasis is still uncertain. This meta-analysis is aimed to appraise the safety and feasibility of LCBDE for elderly patients with choledocholithiasis.
Studies comparing elderly patients and younger patients who underwent LCBDE for common bile duct stone were reviewed and collected from the PubMed, Medline, EMBASE, and Cochrane Library. Primary outcomes were stone clearance rate, overall complication rate, and mortality rate. Secondary outcomes were operative time, conversion rate, pulmonary complication, bile leakage, reoperation, residual stone rate, and recurrent stone rate.
Nine studies, including two prospective studies and seven retrospective studies, met the inclusion criteria. There were 2004 patients in this meta-analysis, including 693 elderly patients and 1311 younger patients. There was no statistically significant difference between elderly patients and younger patients regarding stone clearance rate (OR 0.73; 95% CI 0.42-1.26; p = 0.25), overall complication rate (OR 1.31; 95% CI 0.94-1.82; p = 0.12), and mortality rate (OR 2.80; 95% CI 0.82-9.53; p = 0.10). Similarly, the operative time, conversion rate, bile leakage, reoperation, residual stone rate, and recurrent stone rate showed no significant difference between two groups (p > 0.05). While elderly patients showed high risk for pulmonary complication (OR 4.41; 95% CI 1.78-10.93; p = 0.001) compared with younger patients.
Although there is associated with higher pulmonary complication, LCBDE is still considered as a safe and effective treatment for elderly patients with choledocholithiasis.
腹腔镜胆总管探查术（LCBDE）在有症状的胆总管结石患者中越来越受欢迎。然而，LCBDE 治疗老年胆总管结石患者的安全性和有效性仍不确定。本荟萃分析旨在评估 LCBDE 治疗老年胆总管结石患者的安全性和可行性。
从 PubMed、Medline、EMBASE 和 Cochrane Library 中检索并收集了比较老年患者和年轻患者行 LCBDE 治疗胆总管结石的研究。主要结局指标为结石清除率、总并发症发生率和死亡率。次要结局指标为手术时间、中转率、肺部并发症、胆漏、再次手术、残余结石率和复发性结石率。
共有 9 项研究符合纳入标准，其中包括 2 项前瞻性研究和 7 项回顾性研究。本荟萃分析共纳入 2004 例患者，其中老年患者 693 例，年轻患者 1311 例。老年患者与年轻患者的结石清除率（OR 0.73；95%CI 0.42-1.26；p=0.25）、总并发症发生率（OR 1.31；95%CI 0.94-1.82；p=0.12）和死亡率（OR 2.80；95%CI 0.82-9.53；p=0.10）差异均无统计学意义。同样，两组患者的手术时间、中转率、胆漏、再次手术、残余结石率和复发性结石率差异均无统计学意义（p>0.05）。然而，老年患者肺部并发症的风险较高（OR 4.41；95%CI 1.78-10.93；p=0.001）。
尽管老年患者肺部并发症的风险较高，但 LCBDE 仍被认为是治疗老年胆总管结石患者的一种安全有效的方法。
