Department of General Surgery, The Second Hospital of Lanzhou, Lanzhou, China.
ANZ J Surg. 2021 Jul;91(7-8):E439-E445. doi: 10.1111/ans.16856. Epub 2021 Apr 12.
Left lateral hepatic resection is the preferred surgical approach for treating left hepatolithiasis. However, it is not clear whether cholangioscopy via left hepatic duct (LHD) orifice can replace conventional common bile duct (CBD) approach during laparoscopic procedures.
We performed a comprehensive literature search by screening medical databases, then compared perioperative outcomes and occurrence of recurrent stones between LHD and CBD approaches.
A total of five studies, comprising 345 patients, were included in this meta-analysis. The reported operative times, intra-operative blood loss and incidence of post-operative complications were comparable between the approaches. Pooled results revealed a positive correlation between LHD approach with shorter length of hospital stay (standard mean difference = -1.36; 95% confidence interval: -2.10, -0.61; P < 0.001). Additionally, bile duct exploration via LHD orifice was associated with similar rate of recurrent stones and cholangitis across both groups.
Our results demonstrated that biliary tract exploration via LHD stump can be safely performed in left-sided hepatolithiasis. Additionally, the LHD approach was associated with comparable intra-operative outcomes and shorter post-operative hospitalization relative to CBD approach, and does not increase incidence of stone recurrence.
左肝切除术是治疗左肝内胆管结石的首选手术方法。然而，在腹腔镜手术过程中，通过左肝管（LHD）开口进行胆管镜检查是否可以替代常规胆总管（CBD）入路尚不清楚。
我们通过筛选医学数据库进行了全面的文献检索，然后比较了 LHD 和 CBD 入路的围手术期结果和结石复发的发生率。
这项荟萃分析共纳入了 5 项研究，共 345 例患者。两种方法的手术时间、术中出血量和术后并发症发生率相当。汇总结果显示，LHD 入路与较短的住院时间呈正相关（标准均数差=-1.36；95%置信区间：-2.10，-0.61；P<0.001）。此外，通过 LHD 残端进行胆管探查在两组中结石复发和胆管炎的发生率相似。
我们的研究结果表明，左肝内胆管结石患者可以安全地通过 LHD 残端进行胆道探查。此外，与 CBD 入路相比，LHD 入路的术中结果相当，术后住院时间更短，且不会增加结石复发的发生率。
