Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Tongren Road 27, Xining, 810001, Qinghai, People's Republic of China.
Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, 810000, People's Republic of China.
Clin J Gastroenterol. 2022 Jun;15(3):513-521. doi: 10.1007/s12328-022-01615-7. Epub 2022 Mar 5.
Greater than or equal to 8 mm was often used as the safe diameter of primary duct closure (PDC) after laparoscopic common bile duct exploration (LCBDE) in previous studies, but it is impossible to verify the source of this safe diameter, and lack of evidence for the safe diameter of PDC. Hence, this study evaluates the incidence of postoperative complications by single-arm meta-analysis to demonstrate the feasibility of using 8 mm as the safe diameter of PDC, so as to provide reference for clinical selection. Eligible studies were searched by MEDLINE, the Cochrane Library, Embase, and Web of Science from January 1995 to May 2021, investigating eligible literature using PDC after LCBDE for methods of common bile duct closure. The single-arm meta-analysis was analyzed by "meta" package under R 4.0.5, and the pooled incidence of postoperative complications was calculated. Twelve literatures were enrolled in this single-arm meta-analysis including 792 patients. The pooled complications rate including total complications (13.1%, 95% CI 10.1-15.6%), total biliary duct-related complications (9.4%, 95% CI 7.4-11.6%), residual stones (1.3%, 95% CI 0.3-2.7%), bile leakage (5.1%, 95% CI 3.5-6.9%), postoperative pneumonia (2.1%, 95% CI 0.8-3.8%), postoperative acute pancreatitis (1.8%, 95% CI 0.2-4.3%), and stone recurrence (2.6%, 95% CI 1.1-4.4%). The clinical indication of PDC after LCBDE should follow that the diameter of common bile duct ≥ 8 mm as the safe diameter.
在之前的研究中，腹腔镜胆总管探查术（LCBDE）后，常将大于或等于 8mm 作为原发性胆管闭合（PDC）的安全直径，但无法验证此安全直径的来源，也缺乏 PDC 安全直径的证据。因此，本研究通过单臂荟萃分析评估术后并发症的发生率，以证明使用 8mm 作为 PDC 的安全直径的可行性，为临床选择提供参考。通过 MEDLINE、Cochrane 图书馆、Embase 和 Web of Science 自 1995 年 1 月至 2021 年 5 月检索合格研究，使用 LCBDE 后 PDC 方法对胆总管闭合的合格文献进行调查。使用 R 4.0.5 中的“meta”包对单臂荟萃分析进行分析，并计算术后并发症的总发生率。本单臂荟萃分析共纳入 12 项文献，共 792 例患者。总并发症（13.1%，95%CI 10.1-15.6%）、总胆管相关并发症（9.4%，95%CI 7.4-11.6%）、残余结石（1.3%，95%CI 0.3-2.7%）、胆漏（5.1%，95%CI 3.5-6.9%）、术后肺炎（2.1%，95%CI 0.8-3.8%）、术后急性胰腺炎（1.8%，95%CI 0.2-4.3%）和结石复发（2.6%，95%CI 1.1-4.4%）的汇总发生率。LCBDE 后 PDC 的临床适应证应遵循胆总管直径≥8mm 作为安全直径。
