One-stage laproendoscopic procedure versus two-stage procedure in the management for gallstone disease and biliary duct calculi: a systemic review and meta-analysis
One-stage laproendoscopic procedure versus two-stage procedure in the management for gallstone disease and biliary duct calculi: a systemic review and meta-analysis
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一期腹腔镜手术与两期手术治疗胆结石疾病和胆管结石：系统评价和荟萃分析
DOI：
10.1007/s00464-015-4657-0
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发表时间：
2016-08-01
影响因子：
3.1
通讯作者：
Liang, Tingbo
中科院分区：
文献类型：
--
作者：
Prasson, Pankaj;Bai, Xueli;Liang, Tingbo
背景：腹腔镜胆总管探查和内镜逆行胆管造影术（ERCP）是目前用于治疗胆管结石的安全有效的技术。本研究的目的是评估腹腔镜胆总管探查加腹腔镜胆囊切除术（LCBDE）和ERCP加腹腔镜胆囊切除术（ERCP + LC）的术中疗效和术后结果。方法纳入所有比较一期（LCBDE）和二期（ERCP/EST + LC）治疗合并胆管结石患者的研究。主要结局是CBD结石清除、术后发病率和死亡率，而次要结局是与其他技术的转换、住院时间、每位患者使用的手术次数和手术时间。数据通过荟萃分析汇总。结果共确定了14项涉及1600名参与者的研究。每组有800名参与者。两组在成功清除CBD结石（RR = 0.96，P= 0.15）、死亡率（RR = 1.74，P= 0.33）、发病率（RR = 0.89，P= 0.32）、转行额外手术（RR = 1.44，P= 0.09）、手术时间（MD = - 1.43 min，P= 0.95）、住院时间（MD = 1.31天，P= 0.17）和结石残留率（RR = 1.73，P= 0.38）方面无显著差异。结论一期和二期治疗在CBD结石清除率、死亡率、发病率、手术时间、住院时间和结石残留率方面具有相似的疗效和安全性。一期管理可以减少额外的程序。
BackgroundLaparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography (ERCP) are secure and effective techniques that recently been used to treat bile duct stones. The purpose of this research was to assess the intra-procedural efficacy and postprocedural upshots of the laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE) and ERCP plus laparoscopic cholecystectomy (ERCP + LC).MethodsAll studies contrasting one-stage (LCBDE) with two-stage (ERCP/EST + LC) managements in patients with concomitant gallstones and common bile duct (CBD) stones were included. The primary outcomes were CBD stone clearance, postoperative morbidity, and mortality, while secondary outcomes were conversion with other techniques, duration of stay in hospital, number of procedures used per patient, and operating time. Data were pooled by meta-analysis.ResultsFourteen studies with 1600 participants were identified. Each arm contains 800 participants. There is no significant difference between the two arms regarding successful CBD stone clearance (RR = 0.96,P= 0.15), mortality (RR = 1.74,P= 0.33), morbidity (RR = 0.89,P= 0.32), conversion to additional procedure (RR = 1.44,P= 0.09), operating time (MD = −1.43 min,P= 0.95), hospital stay (MD = 1.31 days,P= 0.17), and retained stone rate (RR = 1.73,P= 0.38).ConclusionsOne- and two-stage management had similar efficacy and safety in terms of CBD stone clearance rate, mortality, morbidity, operating time, hospital stay, and retained stone rate. One-stage management may reduce additional procedure.