腹腔镜胆总管切开取石术与开腹胆总管切开取石术治疗胆总管结石的疗效比较：一项系统评价与Meta分析
Comparison of the efficacy of LTCBDE and LCBDE for common bile duct stones: a systematic review and meta-analysis.
作者信息
Zheng Bin, Lu Yixin, Li Erqi, Bai Ziyu, Zhang Kaiqian, Li Jian
机构信息
Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China.
Department of Cardiovascular Medicine, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China.
出版信息
Front Surg. 2025 Jan 8;11:1412334. doi: 10.3389/fsurg.2024.1412334. eCollection 2024.
BACKGROUND
The choice of surgical methods for common bile duct stones (CBDS) is controversial. The aim of this study was to compare the safety and efficacy of laparoscopic transcystic common bile duct exploration (LTCBDE) and laparoscopic common bile duct exploration (LCBDE).
METHODS
Relevant literature published before March 30, 2023 in PubMed, Web of Science, Embase, and Cochrane was searched to screen studies comparing LTCBDE and LCBDE. RevMan 5.4 was used for meta-analysis of fixed-effects and random-effects models.
RESULTS
A total of 21 studies met the inclusion criteria, including 3065 patients in the LTCBDE group and 2,453 patients in the LCBDE group. CBDS clearance was 95.4% (2,682/2,812) in LTCBDE group and 94.7% (1,810/1,911) in LCBDE group (OR: 1.84, 95% CI: 1.36, 2.48, < 0.0001; = 0%, = 0.56). In LTCBDE group, operative time(MD = -34.60, 95% CI: -46.05, -23, 15, < 0.00001 = 96%, < 0.00001), postoperative hospital stay (MD = -2.92, 95% CI: -3.62, -2.21, < 0.00001; = 92%, < 0.00001), postoperative complications (OR: 0.47, 95% CI: 0.38, 0.58, < 0.0001; = 26%, = 0.15), residual stone(OR: 0.48, 95% CI: 0.34, 0.66, < 0.0001; = 0%, = 0.56), bile leak (OR: 0.37, 95% CI: 0.25, 0.55, < 0.00001; = 0%, = 0.52), mortality (OR: 0.10, 95% CI: 0.01, 0.88, = 0.04; = 0%, = 0.71) and recurrent stones(OR: 0.34, 95% CI: 0.15, 0.74, = 0.007; = 5%, = 0.38) were better than LCBDE group. There was no difference in pancreatitis (OR: 1.06, 95% CI: 0.52, 2.16. = 0.86; = 0%, = 0.98) and biliary stricture(OR: 0.30, 95% CI: 0.08, 1.09, = 0.07; = 0%, = 0.57).
CONCLUSIONS
LTCBDE is safe, efficient, and of great clinical significance, and is worth promoting to some patients.
背景
胆总管结石（CBDS）手术方法的选择存在争议。本研究旨在比较腹腔镜经胆囊管胆总管探查术（LTCBDE）和腹腔镜胆总管探查术（LCBDE）的安全性和有效性。
方法
检索2023年3月30日前在PubMed、Web of Science、Embase和Cochrane上发表的相关文献，以筛选比较LTCBDE和LCBDE的研究。使用RevMan 5.4对固定效应和随机效应模型进行荟萃分析。
结果
共有21项研究符合纳入标准，其中LTCBDE组3065例患者，LCBDE组2453例患者。LTCBDE组胆总管结石清除率为95.4%（2682/2812），LCBDE组为94.7%（1810/1911）（OR：1.84，95%CI：1.36，2.48，<0.0001；I² = 0%，P = 0.56）。LTCBDE组在手术时间（MD = -34.60，95%CI：-46.05，-23.15，<0.00001；I² = 96%，P <0.00001）、术后住院时间（MD = -2.92，95%CI：-3.62，-2.21，<0.00001；I² = 92%，P <0.00001）、术后并发症（OR：0.47，95%CI：0.38，0.58，<0.0001；I² = 26%，P = 0.15）、残余结石（OR：0.48，95%CI：0.34，0.66，<0.0001；I² = 0%，P = 0.56）、胆漏（OR：0.37，95%CI：0.25，0.55，<0.00001；I² = 0%，P = 0.52）、死亡率（OR：0.10，95%CI：0.01，0.88，P = 0.04；I² = 0%，P = 0.71）和复发性结石（OR：0.34，95%CI：0.15，0.74，P = 0.007；I² = 5%，P = 0.38）方面均优于LCBDE组。胰腺炎（OR：1.06，95%CI：0.52，2.16，P = 0.86；I² = 0%，P = 0.98）和胆管狭窄（OR：0.30，95%CI：0.08，1.09，P = 0.07；I² = 0%，P = 0.57）方面两组无差异。
结论
LTCBDE安全、有效，具有重要临床意义，值得向部分患者推广。
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