LC+LTCBDE与LC+LBEPS治疗胆囊结石合并胆总管结石效果比较的Meta分析  

Efficacy comparison of LC combined with LTCBDE versus LC combined with LBEPS in the treatment of cholecystolithiasis complicated with choledocholithiasis:A Meta-analysis

作　　者：王小磊 方骏 王安 杨晓蒙 何博 朱武晖[1] WANG Xiaolei;FANG Jun;WANG An;YANG Xiaomeng;HE Bo;ZHU Wuhui(Department of Hepatobiliary Surgery,the Third People’s Hospital of Qingdao,Qingdao,Shandong 266041,China)

机构地区：[1]青岛市第三人民医院肝胆外科,山东青岛266041

出　　处：《肝胆胰外科杂志》2025年第2期100-107,共8页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的通过Meta分析比较腹腔镜胆囊切除术(LC)联合经胆囊管胆总管探查取石(LTCBDE)与LC联合传统腹腔镜下胆总管切开取石一期缝合(LBEPS)治疗胆囊结石合并胆总管结石的临床疗效。方法在中国知网、万方、维普、中国生物医学文献数据库、PubMed、Web of Science、The Cochrane Library和Embase数据库中检索有关LTCBDE和LBEPS治疗胆囊结石合并胆总管结石的中英文文献,检索的时间范围为数据库建库至2024年4月。结局指标包括手术时间、术中出血量、住院时间、术后胆漏发生率、术后胆管狭窄发生率和术后残余结石发生率等。使用RevMan 5.4软件进行Meta分析。结果共纳入18篇文献,均为较高质量的回顾性队列研究,共涉及2372例患者,其中LC+LTCBDE组1255例,LC+LBEPS组1117例。Meta分析结果显示,LC+LTCBDE组和LC+LBEPS组在手术时间(MD=-21.46,95%CI-27.27--15.65,P<0.001)、术中出血量(MD=-4.85,95%CI-7.93--1.78,P=0.002)、住院时间(MD=-2.44,95%CI-3.15--1.73,P<0.001)、术后胆漏发生率(OR=0.16,95%CI 0.09-0.27,P<0.001)、术后胆管狭窄发生率(OR=0.39,95%CI 0.17-0.93,P=0.03)等方面,差异均具有统计学意义(P<0.05);两组在术后残余结石发生率(OR<0.001,95%CI-0.09-0.09,P=0.94)方面差异无统计学意义(P>0.05)。结论LC+LTCBDE较传统LC+LTCBDE手术时间更短、术中出血量更少,患者住院时间更短、术后胆漏及胆管狭窄发生率更低,具有较好的临床应用价值。但LC+LTCBDE的实施需严格把握手术适应证,建议在具有一定经验的诊疗中心开展。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 1117 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

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 号：R657.4[医药卫生—外科学]