Comparisin of Efficacy and Safety of One-stage LCBDE+LC and Sequential Two-stage ERCP/EST+LC in the Treatment of Cholecystolithiasis Complicated with Choledocholithiasis：a Meta-analysis

doi:10.12114/j.issn.1007-9572.2021.00.462

Abstract

Abstract: Background　Cholecystolithiasis complicated with choledocholithias is a common disease in clinical medication.One-stage Laparoscopic common bile duct exploration（LCBDE） + laparoscopic cholecystectomy（LC） and sequential two-stage endoscopic retrograde cholangiopancreatography（ERCP）/endoscopic sphincterotomy（EST） + LC are both accepted as ideal minimally invasive treatment methods，some domastic and foreign scholars have analyzed and compared the advantages and disadvantages of the two methods，but which method is more advantagous still remains uncertain．Objective　To compare the efficacy and safety of one-stage LCBDE+LC and sequential two-stage ERCP/EST +LC in the treatment of cholecystolithiasis complicated with choledocholithiasis．Methods　Randomized controlled trials（RCTs） comparing the efficacy of one-stage LCBDE+LC and sequential two-stage ERCP/EST+LC were searched from the database including PubMed，EMBase，Web of Science，The Cochrane Library，CNKI and WanFang Data Service Platform from January 2009 to March 2020．The first author's name，country，publishing time，time period of the patients，sample number，age，ratio of female，ratio of multiple stones，common bile duct diameter，ASA grade，follow-up period，outcome indexes（the common bile duct calculi clearance ratio，incidence of postoperative complications，surgical transferation ratio，bile leakage ratio，incidence of pancreatitis，residual stone ratio，calculi recurrence ratio，hospitalization fee，length of hospitalization stay，operation time） were recorde．Meta-analysis was performed using RevMan 5.3 software．Results　A total of 20 RCTs were included in this study，and the overall quality of the literatures was good．Choledoch stone clearance ratio 〔OR=1.11，95%CI（0.78，1.58），P=0.55〕，surgical transferance ratio 〔OR=1.11，95%CI（0.64，1.93），P=0.71〕，residual stone ratio 〔OR=0.73，95%CI（0.45，1.19），P=0.21〕，length of hospitalization stay 〔SWD=-0.43，95%CI（-0.87，0.02），P=0.06〕 and operation time 〔SWD=-0.28，95%CI（-1.09，0.53），P=0.50〕 showed no significant differences between the one-stage LCBDE+LC group and sequential two-stage ERCP/EST+LC group．Compared with the sequential two-stage ERCP/EST+LC group，postoperative complication ratio 〔OR=0.57，95%CI（0.43，0.75），P<0.000 1〕，stone recurrence ratio〔OR=0.33，95%CI（0.16，0.69），P=0.003〕，hospitalization cost 〔SWD=-1.07，95%CI（-1.44，-0.69），P<0.000 01〕，pancreatitis ratio 〔OR=0.13，95%CI（0.06，0.27），P<0.000 01〕 significantly decreased，while the bile leakage ratio 〔OR=3.68，95%CI（2.10，6.45），P<0.000 01〕 significantly increased in the one-stage LCBDE+LC group．Conclusion　Compared with sequential two-stage ERCP/EST+LC，one-stage LCBDE+LC showed lower incidence of total complications，stone recurrence ratio and hospitalization cost，but showed obvious advantages in perioperative safety．There were no significant differences in the stone clearance ratio，operation time，length of hospitalization stay，surgical transferance ratio and residual stone ratio between the two groups．

Key words: Cholecystolithiasis, Choledocholithiasis, Common bile duct exploration, Laparoscopy, Sphincterotomy, Endoscope, Meta analysis

摘要： 背景　胆囊结石合并胆总管结石是临床常见的疾病，一步法腹腔镜胆总管探查术（LCBDE）+腹腔镜胆囊切除术（LC）及序贯二步法内镜逆行胰胆管造影（ERCP）/内镜十二指肠乳头括约肌切开术（EST）+LC均被认为是理想的微创治疗方法，虽然国内外部分学者对两种方案的优劣性进行了比较分析，但究竟哪种方法更有优势尚不确定。目的　比较一步法LCBDE+LC和序贯二步法ERCP/EST+LC治疗胆囊结石合并胆总管结石的有效性及安全性。方法　计算机上检索PubMed、EMBase、Web of Science、The Cochrane Library、中国知网及万方数据知识服务平台等数据库中2009年1月—2020年3月发表的比较一步法LCBDE+LC和序贯二步法ERCP/EST +LC疗效的随机对照研究（RCTs），记录第一作者姓名、国家、发表时间、患者纳入时间段、样本量、年龄、女性比例、多发结石比例、胆总管直径、美国麻醉医师协会（ASA）分级、随访期限、结局指标（胆总管结石清除率、术后并发症发生率、手术中转率、胆漏率、胰腺炎发生率、残留结石率、结石复发率、住院费用、住院时间、手术时间）。应用Revman 5.3软件进行Meta分析。结果　本研究共纳入20项RCTs，文献质量总体质量水平尚可。接受一步法LCBDE+LC和序贯二步法ERCP/EST +LC治疗的患者胆总管结石清除率〔OR=1.11，95%CI（0.78，1.58），P=0.55〕、手术中转率〔OR=1.11，95%CI（0.64，1.93），P=0.71〕、残留结石率〔OR=0.73，95%CI（0.45，1.19），P=0.21〕、住院时间〔SWD=-0.43，95%CI（-0.87，0.02），P=0.06〕、手术时间〔SWD=-0.28，95%CI（-1.09，0.53），P=0.50〕比较，差异均无统计学意义。接受一步法LCBDE+LC治疗的患者的术后并发症发生率〔OR=0.57，95%CI（0.43，0.75），P<0.000 1〕、结石复发率〔OR=0.33，95%CI（0.16，0.69），P=0.003〕、住院费用〔SWD=-1.07，95%CI（-1.44，-0.69），P<0.000 01〕、胰腺炎发生率〔OR=0.13，95%CI（0.06，0.27），P<0.000 01〕低于接受序贯二步法ERCP/EST +LC治疗的患者，胆漏率〔OR=3.68，95%CI（2.10，6.45），P<0.000 01〕高于接受序贯二步法ERCP/EST+LC治疗的患者。结论　与序贯二步法ERCP/EST +LC相比，一步法LCBDE+LC术后并发症发生率、结石复发率、住院费用较低，但围术期安全性增加，胆总管结石清除率、手术时间、住院时间、手术中转率及残留结石率无明显差异。

关键词: 胆囊结石病, 胆总管结石, 胆总管探查术, 腹腔镜检查, 括约肌切开术, 内窥镜, Meta分析

LIN Qiuman,WANG Guiliang,WU Zaoxuan, et al. Comparisin of Efficacy and Safety of One-stage LCBDE+LC and Sequential Two-stage ERCP/EST+LC in the Treatment of Cholecystolithiasis Complicated with Choledocholithiasis：a Meta-analysis　[J]. Chinese General Practice, 2021, 24(14): 1805-1812. DOI: 10.12114/j.issn.1007-9572.2021.00.462.
林秋满,王桂良,吴灶璇等. 一步法LCBDE+LC和序贯二步法ERCP/EST+LC治疗胆囊结石合并胆总管结石有效性及安全性的Meta分析[J]. 中国全科医学, 2021, 24(14): 1805-1812. DOI: 10.12114/j.issn.1007-9572.2021.00.462.

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