腹腔镜胆总管探查术治疗内镜逆行胰胆管造影术失败患者的系统评价和荟萃分析。
Systematic Review and Meta-analysis of Laparoscopic Common Bile Duct Exploration in Patients With Previous Failed Endoscopic Retrograde Cholangiopancreatography.
机构信息
Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
出版信息
Surg Laparosc Endosc Percutan Tech. 2021 May 11;31(5):654-662. doi: 10.1097/SLE.0000000000000949.
BACKGROUND
The aim was to compare the outcomes of laparoscopic common bile duct exploration (LCBDE) after failed endoscopic retrograde cholangiopancreatography (group A) versus primary LCBDE (group B) for the management of gallbladder and common bile duct stones.
MATERIALS AND METHODS
A comprehensive and systematic literature search was performed in several databases, including PubMed, Ovid, and Cochrane Library. Meta-analysis of operative outcomes, postoperative outcomes, and gallstone clearance rates was conducted using random-effect models.
RESULTS
Six studies including 642 patients (239 in group A and 403 in group B) were included. The operative time was longer in group A (P=0.02). The overall complication, bile leakage, conversion, postoperative hospital stay, and reoperation were comparable in group A and group B. Similarly, no significant difference was present concerning the incidence of stone clearance, residual stone, and recurrent stone (P>0.05).
CONCLUSION
LCBDE is an alternative acceptable procedure when removal of common bile duct stones by endoscopic therapy fails.
背景
本研究旨在比较经内镜逆行胰胆管造影术（ERCP）治疗失败后行腹腔镜胆总管探查术（LCBDE）（A 组）与原发性 LCBDE（B 组）治疗胆囊和胆总管结石的结局。
材料与方法
在多个数据库（包括 PubMed、Ovid 和 Cochrane Library）中进行了全面系统的文献检索。使用随机效应模型对手术结果、术后结果和胆囊结石清除率进行了荟萃分析。
结果
共纳入 6 项研究，包括 642 例患者（A 组 239 例，B 组 403 例）。A 组的手术时间更长（P=0.02）。A 组和 B 组的总体并发症、胆漏、中转开腹、术后住院时间和再次手术的发生率相当。同样，结石清除率、残余结石和复发性结石的发生率也无显著差异（P＞0.05）。
结论
当内镜治疗无法取出胆总管结石时，LCBDE 是一种可替代的可行方法。
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