Laparoscopic Common Bile Duct Exploration Combined With Choledochoscopy Versus Open Surgery In The Treatment Of Common Bile Duct Calculi: A Meta Analysis

Objective:To compare the safety and clinical efficacy between laparoscopic common bile duct exploration combined with choledochoscopy and open surgery in the treatment of common bile duct calculi. Methods:Using “common bile duct calculi”,“open surgery”,“laparoscopic common bile duct exploration”,“choledochoscopy”as keywords,search CBMdisc,CNKI, Wan Fang Database,VIP database,Pub Med,the Cochrane Library, EMBASE by computer.To retrieve from the database construction time to December 2014.Manual retrieval published literature about laparoscopic common bile duct exploration combined with choledochoscopy and open surgery in the treatment of common bile duct calculi,and to trace the related references of the included literature,using Revman 5.0 software to complete a Meta analysis of the operation indexes, the odds ratio(OR value),the weighted mean differences(WMD) and 95% confidence interval(95% CI) for the evaluation of curative effect,finally finish and publish the analysis results. Results:There are 21 articles in this Meta-analysis,C hinese articles are 17,English articles are 4,a total of patients are 2600.Meta analysis showed:the efficacy of laparoscopic common bile duct exploration combined with choledochoscopy is better than open surgery in the treatment of common bile duct calculi. In terms of operation time,laparoscope combined with choledochoscope group is longer than open surgery group,the WMD value equal to 6.27,95% confidence interal(4.81, 7.73),P﹤0.05.In terms of intraoperative blood loss,laparoscope combined with choledochoscope group is less than open surgery group,the WMD value is equal to-109.82,95% confidence interal(-112.26,-107.39),P < 0.05.In terms of postoperative ambulation time,laparoscope combined with choledochoscope group is better than open surgery group,the WMD value is equal to-34.56,95% confidence interal(-38.89,-30.24),P < 0.05.In terms of postoperative first flatus time,laparoscope combined with choledochoscope group is lower than open surgery group,the WMD value is equal to-37.54,95% confidence interal(-38.11,-36.98),P < 0.05.In terms of incidence of complications,laparoscope combined with choledochoscope group is better than open surgery group,the O R value is equal to 0.24,95% confidence interal(0.17,0.35).In terms of use of analgesics, laparoscope combined with choledochoscope group is better than open surgery group,the OR value is equal to 0.13,95% confidence interal(0.10,0.18).In terms of calculi residual rate,there were no statistically significant differences between the two groups. Conclutions:In terms of intraoperative blood loss,postoperative ambulation time, postoperative hospitalization time,postoperative first flatus time,use of analgesics, incidence of complications,calculi residual rate,the laparoscope combined with choledochoscope group were superior to the open surgery group.On the operation time,the laparoscope combined with choledochoscope group is longer than the open surgery group.