Wang Xiaoji, Chen Ai, Fu Qiurong, Cai Chunping
Department of Liver and Gallbladder Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China.
Department of Nursing, The First Affiliated Hospital of Hainan Medical University, Haikou, China.
Front Surg. 2021 Nov 16;8:749285. doi: 10.3389/fsurg.2021.749285. eCollection 2021.
Intrahepatic duct (IHD) stones, also known as hepatolithiasis, refers to any intrahepatic stones of the left and right hepatic ducts. It is a benign biliary tract disease with a high recurrence rate, with many complications, and difficulty in radical cure. The aim of this review and meta-analysis is to compare the safety and efficacy of the laparoscopic left lateral hepatectomy (LLLH) and open left lateral hepatectomy (OLLH) for IHD stones. Pubmed, Embase, Cochrane, WangFang Data, and China National Knowledge Infrastructure were searched for randomized controlled trials (RCTs) regarding the comparison of LLLH and OLLH in the treatment of hepatolithiasis. Standard mean difference (SMD), odds ratio (OR), and 95% CI were calculated using the random-effects model or fixed-effects model according to the heterogeneity between studies. From January 01, 2001 to May 30, 2021, 1,056 articles were retrieved, but only 13 articles were finally included for the meta-analysis. The results showed that compared to the OLLH group, LLLH resulted in smaller surgical incision, less intraoperative blood loss, faster postoperative recovery, and fewer postoperative complications (surgical incision: SMD = -3.76, 95% CI: -5.40, -2.12; intraoperative blood loss: SMD = -0.95, 95% CI: -1.69, -0.21; length of hospital stay: SMD = -1.56, 95% CI: -2.37, -0.75; postoperative complications: OR = 0.45, 95% CI: 0.26, 0.78). In the treatment of hepatolithiasis, compared with OLLH, LLLH has the advantages of less intraoperative blood loss, smaller incisions, less postoperative complications, shorter hospital stay, shorter time to first postoperative exhaust, and postoperative ambulation, and rapid postoperative recovery.
肝内胆管（IHD）结石，又称肝内胆管结石，是指左右肝管内的任何肝内结石。它是一种良性胆道疾病，复发率高，并发症多，根治困难。本综述和荟萃分析的目的是比较腹腔镜左外叶肝切除术（LLLH）和开腹左外叶肝切除术（OLLH）治疗IHD结石的安全性和有效性。检索了PubMed、Embase、Cochrane、万方数据和中国知网，以查找关于LLLH和OLLH治疗肝内胆管结石比较的随机对照试验（RCT）。根据研究间的异质性，使用随机效应模型或固定效应模型计算标准化均数差（SMD）、比值比（OR）和95%可信区间（CI）。2001年1月1日至2021年5月30日，共检索到1056篇文章，但最终仅纳入13篇文章进行荟萃分析。结果显示，与OLLH组相比，LLLH手术切口更小、术中出血量更少、术后恢复更快、术后并发症更少（手术切口：SMD = -3.76，95%CI：-5.40，-2.12；术中出血量：SMD = -0.95，95%CI：-1.69，-0.21；住院时间：SMD = -1.56，95%CI：-2.37，-0.75；术后并发症：OR = 0.45，95%CI：0.26，0.78）。在肝内胆管结石的治疗中，与OLLH相比，LLLH具有术中出血量少、切口小、术后并发症少、住院时间短、首次排气时间短、术后下床活动早以及术后恢复快等优点。
