LC+LCBDE与ERCP/EST+LC治疗胆囊结石合并胆总管结石效果Meta分析

Efficacy of LC+LCBDE and ERCP/EST+LC in the treatment of gallbladder stones complicated with common bile duct stones:a Meta-analysis

目的系统评价LC联合胆总管探查术(LCBDE)和LC联合ERCP/内镜下乳头括约肌切开取石术(EST)两种手术方式治疗胆囊结石合并胆总管结石的安全性及有效性。方法计算机检索CNKI、VIP、万方等中文数据库和PubMed、Embase、Medline、Cochrane Library等外文数据库。英文检索词:gallbladder stones、common bile duct stones、endoscopy、duodenal sphincterotomy、laparoscopic choledochotomy;中文检索词:胆囊结石合并胆总管结石、内窥镜、十二指肠括约肌切开术、腹腔镜胆总管切开探查术等。检索时间为2005年1月1日至2022年1月1日,按照预先设定的纳入和排除标准,两名研究者对检索所得文献进行筛选、数据提取,采用RevMan 5.4软件进行Meta分析。结果最终纳入11个RCT,共1701例患者,其中LC+LCBDE组883例,ERCP/EST+LC组818例。两组患者结石清除率(OR=0.85,95%CI:0.59~1.22)、手术中转率(OR=1.46,95%CI:0.81~2.62)差异无统计学意义(P>0.05);两组手术时间(WMD=11.26,95%CI:-13.38~35.89)、住院时间(WMD=-0.65,95%CI:-1.55~0.16)差异亦无统计学意义(P>0.05)。两组术后胆漏(OR=4.89,95%CI:2.13~11.21)、胰腺炎发生率(OR=0.15,95%CI:0.06~0.37)差异有统计学意义(P<0.05)。结论两种不同手术方式均是安全、有效的胆囊结石合并胆总管结石治疗手段,LC联合LCBDE术后胰腺炎发生率更低,而LC联合ERCP/EST的胆漏发生率更低。

Objective To systematically evaluate the safety and efficacy of laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct exploration(LCBDE)and LC combined with endoscopic retrograde cholangiopancreatography(ERCP)/endoscopic sphincterotomy(EST)in the treatment of gallbladder stones complicated with common bile duct stones.Methods Literature review was performed from CNKI,VIP and Wanfang Data,PubMed,Embase,Medline and Cochrane Library using the searching keywords of gallbladder stones,common bile duct stones,endoscopy,duodenal sphincterotomy,laparoscopic choledochotomy in both English and Chinese from January 1,2005 to January 1,2022.According to the inclusion and exclusion criteria,two researchers screened the retrieved literatures and extracted data.Meta-analysis was conducted by RevMan 5.4 software.Results 1701 patients from 11 RCTs were included,including 883 patients in the LC+LCBDE group and 818 in the ERCP/EST+LC group.No significant differences were observed in stone clearance rate(OR=0.85,95%CI:0.59-1.22)and surgical conversion rate(OR=1.46,95%CI:0.81-2.62)between two groups(P>0.05).No significant differences were noted in the operation time(WMD=11.26,95%CI:-13.38-35.89)and length of hospital stay(WMD=-0.65,95%CI:-1.55-0.16)between two groups(P>0.05).The incidence of postoperative bile leakage(OR=4.89,95%CI:2.13-11.21)and pancreatitis(OR=0.15,95%CI:0.06-0.37)significantly differed between two groups(P<0.05).Conclusions Both two surgical procedures are safe and effective treatment for gallbladder stones complicated with common bile duct stones.The incidence of pancreatitis after LC combined with LCBDE is lower,whereas the incidence of bile leakage after LC combined with ERCP/EST is lower.