王小磊 1方骏 1王安 1杨晓蒙 1何博 1朱武晖1
作者信息
- 1. 青岛市第三人民医院肝胆外科,山东 青岛 266041
- 折叠
摘要
Abstract
Objective To compare the clinical efficacy of laparoscopic cholecystectomy(LC)combined with laparoscopic transcystic common bile duct exploration(LTCBDE)versus LC combined with traditional laparoscopic common bile duct exploration and primary suture(LBEPS)in the treatment of cholecystolithiasis complicated with choledocholithiasis.Methods Chinese and English literatures on LC+LTCBDE and LC+LBEPS for the treatment of cholecystolithiasis complicated with choledocholithiasis were retrieved from databases of CNKI,Wanfang Database,VIP Database,Chinese Biomedical Literature Database,PubMed,Web of Science,The Cochrane Library,and Embase Database.The search spanned from the inception of each database to Apr.2024.Outcome measures of interest included the operation time,intraoperative blood loss,length of hospital stay,incidence of postoperative bile leakage,postoperative biliary stricture,and postoperative residual stones.Meta-analysis was performed using RevMan 5.4 software.Results A total of 18 high quality retrospective cohort studies were included in this study,and 2372 cases were involved:1255 cases in the LC+LTCBDE group and 1 117 cases in the LC+LBEPS group.Meta-analysis revealed statistically significant differences between the two groups in operation time(MD=-21.46,95%CI-27.27 to-15.65,P<0.001),intraoperative blood loss(MD=-4.85,95%CI-7.93 to-1.78,P=0.002),length of hospital stay(MD=-2.44,95%CI-3.15 to-1.73,P<0.001),and the incidence of postoperative bile leakage(OR=0.16,95%CI 0.09 to 0.27,P<0.001)and postoperative biliary stricture(OR=0.39,95%CI 0.17 to 0.93,P=0.03).There was no statistically significant difference in the incidence of postoperative residual stones between the two groups(OR<0.001,95%CI-0.09 to 0.09,P=0.94).Conclusion LC+LTCBDE offers superior clinical advantages over traditional LC+LTCBDE,including shorter operation time,less intraoperative blood loss,shorter length of hospital stay,and lower incidence of postoperative bile leakage and postoperative biliary stricture.However,it necessitates strict adherence to surgical indications and should be performed at specialized centers with extensive clinical experience.关键词
胆囊结石/胆总管结石/腹腔镜经胆囊管胆总管探查取石/腹腔镜胆总管切开取石一期缝合/腹腔镜胆囊切除术/手术时间/术中出血量/住院时间/胆漏/胆管狭窄/结石残留/Meta分析分类
临床医学
