Delgado Lucas Monteiro, Pompeu Bernardo Fontel, Pasqualotto Eric, Martins Gabriel Henrique Acedo, Moraes Clara de Jesus, Guedes Lucas Soares de Souza Pinto, Poli de Figueiredo Sergio Mazzola
Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.
Department of General Surgery, Heliopolis Hospital, São Paulo, Brazil.
J Laparoendosc Adv Surg Tech A. 2025 Jun;35(6):463-475. doi: 10.1089/lap.2025.0048. Epub 2025 May 5.
Laparoscopic common bile duct exploration (LCBDE) is a critical procedure for managing choledocholithiasis, with primary closure (PC) and T-tube drainage (TTD) as common methods for common bile duct closure. However, the substantial number of new studies comparing PC and TTD underscores the need for an updated meta-analysis. Therefore, this study aims to compare surgery-related outcomes in PC and TTD for biliary duct closure following LCBDE. We searched PubMed, Embase, and Cochrane Library databases on June 20, 2024. Mean differences (MDs) and risk ratios with 95% confidence intervals (CIs) were pooled for continuous and binary outcomes, respectively. Heterogeneity was assessed with statistics. Statistical analysis was performed using Software R, version 4.3.3. A total of 31 studies comprising 4432 patients were included. A total of 2301 (51.9%) were submitted to PC and 2131 (48.1%) were submitted to TTD. The mean age of patients ranged from 39 to 69.8 years and 44.3% were male. Compared with TTD, PC significantly reduced retained stones (odds ratio [OR] 0.57; 95% CI 0.35-0.93; = .02; = 0%), biliary peritonitis (OR 0.22; 95% CI 0.08-0.60; .01; = 0%), operative time (MD -21.07 minutes; 95% CI -27.68-14.46; . 01; = 97%) and postoperative hospital stay (MD -2.20 days; 95% CI -2.80-1.60; . 01; = 96%). However, there were no significant differences between the groups in recurrent stones (OR 0.57; 95% CI 0.32-1.02; = .06; = 0%), bile leakage (OR 0.89; 95% CI 0.65-1.23; = .49; = 0%), bile duct stricture (OR 2.08; 95% CI 0.36-12.11; = .42; = 0%), pneumonia (OR 1.38; 95% CI 0.66-2.88; = .39; = 0%), and pancreatitis (OR 0.64; 95% CI 0.29-1.38; = .25; = 0%). In this meta-analysis, PC was associated with decreased retained stones, biliary peritonitis, operative time, and postoperative hospital stay. However, no significant differences were observed for the other outcomes. These findings underscore PC as a safe and reliable method for bile duct closure following LCBDE.
腹腔镜胆总管探查术（LCBDE）是治疗胆总管结石的关键手术，一期缝合（PC）和T管引流（TTD）是胆总管闭合的常用方法。然而，大量比较PC和TTD的新研究凸显了更新荟萃分析的必要性。因此，本研究旨在比较LCBDE术后PC和TTD在胆管闭合方面的手术相关结局。我们于2024年6月20日检索了PubMed、Embase和Cochrane图书馆数据库。分别对连续型和二分类结局汇总了具有95%置信区间（CI）的平均差（MD）和风险比。用统计学方法评估异质性。使用R软件4.3.3版进行统计分析。共纳入31项研究，包括4432例患者。共有2301例（51.9%）接受了PC，2131例（48.1%）接受了TTD。患者的平均年龄在39至69.8岁之间，男性占44.3%。与TTD相比，PC显著降低了残留结石（优势比[OR]0.57；95%CI 0.35 - 0.93；P = 0.02；I² = 0%）、胆汁性腹膜炎（OR 0.22；95%CI 0.08 - 0.60；P < 0.01；I² = 0%）、手术时间（MD -21.07分钟；95%CI -27.68至 -14.46；P < 0.01；I² = 97%）和术后住院时间（MD -2.20天；95%CI -2.80至 -1.60；P < 0.01；I² = 96%）。然而，两组在复发性结石（OR 0.57；95%CI 0.32 - 1.02；P = 0.06；I² = 0%）、胆漏（OR 0.89；95%CI 0.65 - 1.23；P = 0.49；I² = 0%）、胆管狭窄（OR 2.08；95%CI 0.36 - 12.11；P = 0.42；I² = 0%）、肺炎（OR 1.38；95%CI 0.66 - 2.88；P = 0.39；I² = 0%）和胰腺炎（OR 0.64；95%CI 0.29 - 1.38；P = 0.25；I² = 0%）方面无显著差异。在这项荟萃分析中，PC与残留结石、胆汁性腹膜炎、手术时间和术后住院时间的减少相关。然而，在其他结局方面未观察到显著差异。这些发现强调了PC是LCBDE术后胆管闭合的一种安全可靠的方法。
