Department of Surgery, Suichang County People's Hospital, Lishui, China.
Eur Rev Med Pharmacol Sci. 2023 May;27(10):4656-4669. doi: 10.26355/eurrev_202305_32477.
This study aimed to compare the efficacy and safety of laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) to determine which one provides a better outcome for patients with gallbladder and common bile duct stones.
An electronic literature search was undertaken using Embase, Medline, PubMed, and Cochrane Library databases up to April 2022. For quality assessment of included studies, randomized controlled trials (RCTs) were assessed by utilizing the Jadad scale. The primary outcome includes surgical success rate, retained stone rate, stone clearance rate, major morbidity, and mortality. The second outcome includes conversion to open surgery rate, postoperative pancreatitis, bile leakage, cholangitis, hemorrhage, pneumonia, and surgical-site infection.
14 randomized controlled trials with 2,181 patients were included. No significant difference was seen between the two groups in terms of surgical success, stone clearance, retained stones, operation time, and total morbidity. LC-LCBDE had higher rate of bile leakage [relative risk (RR): 4.52; 95% confidence interval (CI): 2.19-9.31] and lower rate of postoperative pancreatitis (RR: 0.25; 95% CI: 0.13-0.46), cholangitis (RR: 0.17; 95% CI: 0.05-0.67), and hemorrhage (RR: 0.18; 95% CI: 0.07-0.42).
Both LC+LCBDE and LC+ERCP are safe, effective, and minimal-invasive treatments for concomitant gallbladder and CBD stones. LC-LCBDE was associated with comparable effects compared with LC+ERCP in terms of surgical success rate, stone clearance rate, retained stones rate, operation time, and total morbidity. At the same time, LC-LCBDE had a higher rate of bile leakage and a lower rate of postoperative pancreatitis, cholangitis, and hemorrhage.
本研究旨在比较腹腔镜胆总管探查术（LCBDE）和内镜逆行胰胆管造影术（ERCP）联合腹腔镜胆囊切除术（LC）的疗效和安全性，以确定哪种方法为胆囊和胆总管结石患者提供更好的治疗效果。
通过 Embase、Medline、PubMed 和 Cochrane Library 数据库进行电子文献检索，检索时间截至 2022 年 4 月。对于纳入研究的质量评估，采用 Jadad 量表对随机对照试验（RCT）进行评估。主要结局包括手术成功率、残余结石率、结石清除率、主要发病率和死亡率。次要结局包括转为开腹手术率、术后胰腺炎、胆漏、胆管炎、出血、肺炎和手术部位感染。
纳入了 14 项 RCT，共 2181 名患者。两组在手术成功率、结石清除率、残余结石、手术时间和总发病率方面无显著差异。LC-LCBDE 术后胆漏发生率较高[相对风险（RR）：4.52；95%置信区间（CI）：2.19-9.31]，术后胰腺炎（RR：0.25；95%CI：0.13-0.46）、胆管炎（RR：0.17；95%CI：0.05-0.67）和出血（RR：0.18；95%CI：0.07-0.42）发生率较低。
LC+LCBDE 和 LC+ERCP 都是安全有效的微创治疗胆囊和胆总管结石的方法。LC-LCBDE 在手术成功率、结石清除率、残余结石率、手术时间和总发病率方面与 LC+ERCP 相比具有相似的效果。同时，LC-LCBDE 术后胆漏发生率较高，术后胰腺炎、胆管炎和出血发生率较低。
