Abstract
Background and aims
Laparoscopic common bile duct exploration (LCBDE) is considered a safe and effective method for the removal of bile duct stones. However, the choice of primary duct closure (PDC) or T-tube drainage (TTD) technique after LCBDE is still controversial. This study aimed to compare the safety and effectiveness of PDC and TTD after LCBDE.
Methods
Studies published before May 1, 2021 in PubMed, Web of Science, and Cochrane Library databases were searched to screen out randomized controlled trials (RCTs) and cohort studies to compare PDC with TTD. Meta-analyses of fixed effect and random effect models were performed using RevMan 5.3.
Results
A total of 1865 patients were enrolled in six RCTs and ten cohort studies. Regarding RCTs, the PDC group was significantly better than the TTD group in terms of operation time, total postoperative complications, postoperative hospital stay, and hospitalization expenses (all P<0.05). Based on cohort studies of the subgroup, the PDC group had shorter operation time, shorter postoperative hospital stay, less intraoperative blood loss, and limited total postoperative complications. Statistically, there were no significant differences in bile leakage, retained stones, stone recurrence, bile duct stricture, postoperative pancreatitis, other complications, or postoperative exhaust time between the TTD and PDC groups.
Conclusions
Based on the available evidence, compared with TTD, PDC is safe and effective, and can be used as the first choice after transductal LCBDE in patients with choledocholithiasis.
概要
创新点
(1) 本研究纳入了 6 项随机对照研究和 10 项队列研究(共 1865 例患者), 并且将队列研究作为亚组单独分析, 因此在扩大样本量的基础上控制了偏倚的风险; (2) 考虑到事件发生率较高时比值比 (OR) 得出的效应值会被高估, 本研究首先选择相对危险度 (RR) 比较二分类变量; (3) 本研究排除了有胆道手术史的患者, 减少了研究的异质性, 因此获得了 RR 分布基本对称的贝格漏斗图, 研究结果质量较高.
目的
腹腔镜胆总管探查术是一种安全有效的取石方法, 然而术后胆管一期缝合或T管引流的选择仍存在争议. 本研究旨在比较一期缝合和T管引流的安全性和有效性.
方法
本研究在PubMed、 Web of Science和Cochrane Library数据库中检索2021年5月1日前发表的文章, 筛选出比较一期缝合与T管引流的随机对照研究和队列研究; 使用Revman 5.3进行meta分析, 并对队列研究进行了预先指定的亚组分析; 采用Cochran’s Q检验和Higgins I2统计量评估研究之间的异质性. 在纳入的研究中没有检测到显著的异质性(I2≤50%, P≥0.10)时, 采用固定效应模型(Mantel-Haenszel法); 当检测到显著的异质性(P<0.10或I2>50%)时, 采用随机效应模型(DerSimonian和Laird法). 同时, 使用贝格漏斗图衡量文章发表的偏倚, 用RR和加权均数差 (WMD) 分别比较二分类变量和连续变量.
结论
相比T管引流, 腹腔镜胆总管探查术后胆管一期缝合显著减少了手术时间、 术中出血量、 术后总并发症、 术后住院时间和住院费用; 在胆漏、 结石残留、 结石复发、 胆管狭窄、 术后胰腺炎、 其他并发症和术后排气时间方面两者的效果则相当. 因此, 我们强烈建议有足够经验的外科医生首选一期缝合.
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Acknowledgments
This work was supported by the National Natural Science Foundation of China (Nos. 81972262, 81972255, 81772597, 81801999, and 81702904), the Guangdong Basic and Applied Basic Research Foundation (Nos. 2020A1515010117 and 2018A030313645), the Fundamental Research Funds for the Central Universities (No. 18ykpy22), the Key Laboratory of Malignant Tumor Molecular Mechanism and Translational Medicine of Guangzhou Bureau of Science and Information Technology (No. [2013]163), the Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes (No. KLB09001), the Guangdong Science and Technology Department (Nos. 2015B050501004 and 2017B030314026), and the Shangrao Science and Technology Department (No. 2020D001), China.
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Rui ZHANG and Chao LIU: study concept and design; Taifeng ZHU: drafting of the manuscript; Taifeng ZHU and Rui ZHANG: preliminary screening, acquisition of data and full-text evaluation; Haoming LIN and Jian SUN: critical revision of the manuscript; Chao LIU: study supervision. All authors have contributed to the revision of the manuscript. All authors have read and approved the final manuscript, and therefore, have full access to all the data in the study and take responsibility for the integrity and security of the data.
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Taifeng ZHU, Haoming LIN, Jian SUN, Chao LIU, and Rui ZHANG declare that they have no conflict of interest.
This article does not contain any studies with human or animal subjects performed by any of the authors.
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Zhu, T., Lin, H., Sun, J. et al. Primary duct closure versus T-tube drainage after laparoscopic common bile duct exploration: a meta-analysis. J. Zhejiang Univ. Sci. B 22, 985–1001 (2021). https://doi.org/10.1631/jzus.B2100523
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DOI: https://doi.org/10.1631/jzus.B2100523