Bin Zheng, Yixin Lu, Erqi Li, Ziyu Bai, Kaiqian Zhang, Jian Li
{"title":"LTCBDE和LCBDE治疗胆总管结石的疗效比较：系统回顾和荟萃分析。","authors":"Bin Zheng, Yixin Lu, Erqi Li, Ziyu Bai, Kaiqian Zhang, Jian Li","doi":"10.3389/fsurg.2024.1412334","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The choice of surgical methods for common bile duct stones (CBDS) is controversial. The aim of this study was to compare the safety and efficacy of laparoscopic transcystic common bile duct exploration (LTCBDE) and laparoscopic common bile duct exploration (LCBDE).</p><p><strong>Methods: </strong>Relevant literature published before March 30, 2023 in PubMed, Web of Science, Embase, and Cochrane was searched to screen studies comparing LTCBDE and LCBDE. RevMan 5.4 was used for meta-analysis of fixed-effects and random-effects models.</p><p><strong>Results: </strong>A total of 21 studies met the inclusion criteria, including 3065 patients in the LTCBDE group and 2,453 patients in the LCBDE group. CBDS clearance was 95.4% (2,682/2,812) in LTCBDE group and 94.7% (1,810/1,911) in LCBDE group (OR: 1.84, 95% CI: 1.36, 2.48, <i>P</i> < 0.0001; <i>I</i> <sup>2</sup> = 0%, <i>P</i> = 0.56). In LTCBDE group, operative time(MD = -34.60, 95% CI: -46.05, -23, 15, <i>P</i> < 0.00001 <i>I</i> <sup>2</sup> = 96%, <i>P</i> < 0.00001), postoperative hospital stay (MD = -2.92, 95% CI: -3.62, -2.21, <i>P</i> < 0.00001; <i>I</i> <sup>2</sup> = 92%, <i>P</i> < 0.00001), postoperative complications (OR: 0.47, 95% CI: 0.38, 0.58, <i>P</i> < 0.0001; <i>I</i> <sup>2</sup> = 26%, <i>P</i> = 0.15), residual stone(OR: 0.48, 95% CI: 0.34, 0.66, <i>P</i> < 0.0001; <i>I</i> <sup>2</sup> = 0%, <i>P</i> = 0.56), bile leak (OR: 0.37, 95% CI: 0.25, 0.55, <i>P</i> < 0.00001; <i>I</i> <sup>2</sup> = 0%,<i>P</i> = 0.52), mortality (OR: 0.10, 95% CI: 0.01, 0.88, <i>P</i> = 0.04; <i>I</i> <sup>2</sup> = 0%, <i>P</i> = 0.71) and recurrent stones(OR: 0.34, 95% CI: 0.15, 0.74, <i>P</i> = 0.007; <i>I</i> <sup>2</sup> = 5%, <i>P</i> = 0.38) were better than LCBDE group. There was no difference in pancreatitis (OR: 1.06, 95% CI: 0.52, 2.16. <i>P</i> = 0.86; <i>I</i> <sup>2</sup> = 0%, <i>P</i> = 0.98) and biliary stricture(OR: 0.30, 95% CI: 0.08, 1.09, <i>P</i> = 0.07; <i>I</i> <sup>2</sup> = 0%, <i>P</i> = 0.57).</p><p><strong>Conclusions: </strong>LTCBDE is safe, efficient, and of great clinical significance, and is worth promoting to some patients.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"11 ","pages":"1412334"},"PeriodicalIF":1.6000,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750767/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparison of the efficacy of LTCBDE and LCBDE for common bile duct stones: a systematic review and meta-analysis.\",\"authors\":\"Bin Zheng, Yixin Lu, Erqi Li, Ziyu Bai, Kaiqian Zhang, Jian Li\",\"doi\":\"10.3389/fsurg.2024.1412334\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The choice of surgical methods for common bile duct stones (CBDS) is controversial. The aim of this study was to compare the safety and efficacy of laparoscopic transcystic common bile duct exploration (LTCBDE) and laparoscopic common bile duct exploration (LCBDE).</p><p><strong>Methods: </strong>Relevant literature published before March 30, 2023 in PubMed, Web of Science, Embase, and Cochrane was searched to screen studies comparing LTCBDE and LCBDE. RevMan 5.4 was used for meta-analysis of fixed-effects and random-effects models.</p><p><strong>Results: </strong>A total of 21 studies met the inclusion criteria, including 3065 patients in the LTCBDE group and 2,453 patients in the LCBDE group. CBDS clearance was 95.4% (2,682/2,812) in LTCBDE group and 94.7% (1,810/1,911) in LCBDE group (OR: 1.84, 95% CI: 1.36, 2.48, <i>P</i> < 0.0001; <i>I</i> <sup>2</sup> = 0%, <i>P</i> = 0.56). In LTCBDE group, operative time(MD = -34.60, 95% CI: -46.05, -23, 15, <i>P</i> < 0.00001 <i>I</i> <sup>2</sup> = 96%, <i>P</i> < 0.00001), postoperative hospital stay (MD = -2.92, 95% CI: -3.62, -2.21, <i>P</i> < 0.00001; <i>I</i> <sup>2</sup> = 92%, <i>P</i> < 0.00001), postoperative complications (OR: 0.47, 95% CI: 0.38, 0.58, <i>P</i> < 0.0001; <i>I</i> <sup>2</sup> = 26%, <i>P</i> = 0.15), residual stone(OR: 0.48, 95% CI: 0.34, 0.66, <i>P</i> < 0.0001; <i>I</i> <sup>2</sup> = 0%, <i>P</i> = 0.56), bile leak (OR: 0.37, 95% CI: 0.25, 0.55, <i>P</i> < 0.00001; <i>I</i> <sup>2</sup> = 0%,<i>P</i> = 0.52), mortality (OR: 0.10, 95% CI: 0.01, 0.88, <i>P</i> = 0.04; <i>I</i> <sup>2</sup> = 0%, <i>P</i> = 0.71) and recurrent stones(OR: 0.34, 95% CI: 0.15, 0.74, <i>P</i> = 0.007; <i>I</i> <sup>2</sup> = 5%, <i>P</i> = 0.38) were better than LCBDE group. There was no difference in pancreatitis (OR: 1.06, 95% CI: 0.52, 2.16. <i>P</i> = 0.86; <i>I</i> <sup>2</sup> = 0%, <i>P</i> = 0.98) and biliary stricture(OR: 0.30, 95% CI: 0.08, 1.09, <i>P</i> = 0.07; <i>I</i> <sup>2</sup> = 0%, <i>P</i> = 0.57).</p><p><strong>Conclusions: </strong>LTCBDE is safe, efficient, and of great clinical significance, and is worth promoting to some patients.</p>\",\"PeriodicalId\":12564,\"journal\":{\"name\":\"Frontiers in Surgery\",\"volume\":\"11 \",\"pages\":\"1412334\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-01-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750767/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Frontiers in Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3389/fsurg.2024.1412334\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fsurg.2024.1412334","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
背景：胆总管结石（CBDS）手术方法的选择存在争议。本研究的目的是比较腹腔镜经囊胆总管探查（LTCBDE）和腹腔镜胆总管探查（LCBDE）的安全性和有效性。方法：检索2023年3月30日前在PubMed、Web of Science、Embase、Cochrane等网站发表的相关文献，筛选LTCBDE与LCBDE的比较研究。采用RevMan 5.4对固定效应和随机效应模型进行meta分析。结果：共有21项研究符合纳入标准，其中LTCBDE组3065例，LCBDE组2453例。LTCBDE组CBDS清除率为95.4% (2,682/2,812)，LCBDE组为94.7% (1,810/1,911)（OR: 1.84, 95% CI: 1.36, 2.48, pi = 0%, P = 0.56）。LTCBDE组,手术时间(MD = -34.60, 95% CI: -46.05, -23年15日P I 2 = 96%, P P我2 = 92%,P P我2 = 26%,P = 0.15),残石(OR: 0.48, 95% CI: 0.34, 0.66, P I 2 = 0%, P = 0.56),胆汁泄漏(OR: 0.37, 95% CI: 0.25, 0.55, P I 2 = 0%, P = 0.52),死亡率(OR: 0.10, 95% CI: 0.01, 0.88, P = 0.04;我2 = 0%,P = 0.71)和复发性肾结石(OR: 0.34, 95% CI: 0.15, 0.74, P = 0.007;I 2 = 5%, P = 0.38)优于LCBDE组。两组在胰腺炎方面无差异（OR: 1.06, 95% CI: 0.52, 2.16）。p = 0.86；我2 = 0%,P = 0.98),胆道狭窄(OR: 0.30, 95% CI: 0.08, 1.09, P = 0.07;i2 = 0%, p = 0.57)。结论：LTCBDE安全、有效，具有重要的临床意义，值得在部分患者中推广。
Comparison of the efficacy of LTCBDE and LCBDE for common bile duct stones: a systematic review and meta-analysis.
Background: The choice of surgical methods for common bile duct stones (CBDS) is controversial. The aim of this study was to compare the safety and efficacy of laparoscopic transcystic common bile duct exploration (LTCBDE) and laparoscopic common bile duct exploration (LCBDE).
Methods: Relevant literature published before March 30, 2023 in PubMed, Web of Science, Embase, and Cochrane was searched to screen studies comparing LTCBDE and LCBDE. RevMan 5.4 was used for meta-analysis of fixed-effects and random-effects models.
Results: A total of 21 studies met the inclusion criteria, including 3065 patients in the LTCBDE group and 2,453 patients in the LCBDE group. CBDS clearance was 95.4% (2,682/2,812) in LTCBDE group and 94.7% (1,810/1,911) in LCBDE group (OR: 1.84, 95% CI: 1.36, 2.48, P < 0.0001; I2 = 0%, P = 0.56). In LTCBDE group, operative time(MD = -34.60, 95% CI: -46.05, -23, 15, P < 0.00001 I2 = 96%, P < 0.00001), postoperative hospital stay (MD = -2.92, 95% CI: -3.62, -2.21, P < 0.00001; I2 = 92%, P < 0.00001), postoperative complications (OR: 0.47, 95% CI: 0.38, 0.58, P < 0.0001; I2 = 26%, P = 0.15), residual stone(OR: 0.48, 95% CI: 0.34, 0.66, P < 0.0001; I2 = 0%, P = 0.56), bile leak (OR: 0.37, 95% CI: 0.25, 0.55, P < 0.00001; I2 = 0%,P = 0.52), mortality (OR: 0.10, 95% CI: 0.01, 0.88, P = 0.04; I2 = 0%, P = 0.71) and recurrent stones(OR: 0.34, 95% CI: 0.15, 0.74, P = 0.007; I2 = 5%, P = 0.38) were better than LCBDE group. There was no difference in pancreatitis (OR: 1.06, 95% CI: 0.52, 2.16. P = 0.86; I2 = 0%, P = 0.98) and biliary stricture(OR: 0.30, 95% CI: 0.08, 1.09, P = 0.07; I2 = 0%, P = 0.57).
Conclusions: LTCBDE is safe, efficient, and of great clinical significance, and is worth promoting to some patients.
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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