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首页> 中文期刊> 《国际肝胆胰疾病杂志（英文版）》 >Various approaches of laparoscopic common bile duct exploration plus primary duct closure for choledocholithiasis: A systematic review and meta-analysis

Various approaches of laparoscopic common bile duct exploration plus primary duct closure for choledocholithiasis: A systematic review and meta-analysis

         
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摘要

Background: Common bile duct (CBD) stones may occur in up to 3%–14.7% of all patients with chole-cystectomy. Various approaches of laparoscopic CBD exploration plus primary duct closure (PDC) are the most commonly used and the best methods to treat CBD stone. This systematic review was to com-pare the effectiveness and safety of the various approaches of laparoscopic CBD exploration plus PDC for choledocholithiasis. Data sources: Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) (case-control studies or cohort studies) were searched from Cochrane library (until Issue 2, 2015), Web of Science (1980-January 2016), PubMed (1966-January 2016), and Baidu search engine. After independent quality assessment and data extraction, meta-analysis was conducted using RevMan 5.1 software. Results: Four RCTs and 18 NRCTs were included. When compared with choledochotomy exploration (CE) plus T-tube drainage (TTD) (CE+ TTD), CE plus PDC (CE+ PDC) and CE+ PDC with biliary drainage (BD) (CE+ PDC+ BD) had a lower rate of postoperative biliary peritonitis (OR= 0.22; 95% CI: 0.06, 0.88;P<0.05; OR= 0.27; 95% CI: 0.08, 0.84; P<0.05; respectively) where T-tubes were removed more than 3 weeks. The operative time of CE+ PDC was significantly shorter (WMD= -24.82; 95% CI: ? 27.48,? 22.16; P<0.01) than that of CE+ TTD in RCTs. Cystic duct exploration (CDE) plus PDC (CDE+ PDC) has a lower rate of postoperative complications (OR= 0.39; 95% CI: 0.23, 0.67; P<0.01) when compared with CE+ PDC. Confluence part micro-incision exploration (CME) plus PDC (CME+ PDC) has a lower rate of postoperative bile leakage (OR= 0.17; 95% CI: 0.04, 0.74; P<0.05) when compared with CE+ PDC. Conclusion: PDC with other various approaches are better than TTD in the treatment of choledocholithi-asis.

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  • 来源
    《国际肝胆胰疾病杂志（英文版）》 |2018年第3期|183-191|共9页
  • 作者

    Ming-Yan He; Xia-Dong Zhou; Hao Chen; Peng Zheng; Fa-Zhan Zhang; Wei-Wei Ren;

  • 作者单位

    Department of the Third Abdominal Surgery, Gansu Province Cancer Hospital, 2 Xiaoxihu East Street, Qilihe, Lanzhou 730050, China;

    Department of the Third Abdominal Surgery, Gansu Province Cancer Hospital, 2 Xiaoxihu East Street, Qilihe, Lanzhou 730050, China;

    Department of General Surgery, Second Hospital of Lanzhou University, Lanzhou 730030, China;

    Department of the Third Abdominal Surgery, Gansu Province Cancer Hospital, 2 Xiaoxihu East Street, Qilihe, Lanzhou 730050, China;

    Department of the Third Abdominal Surgery, Gansu Province Cancer Hospital, 2 Xiaoxihu East Street, Qilihe, Lanzhou 730050, China;

    Department of the Third Abdominal Surgery, Gansu Province Cancer Hospital, 2 Xiaoxihu East Street, Qilihe, Lanzhou 730050, China;

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