Meta-analysis Of Laparoscopy Combined With Choledochoscopy And Open Surgery Intreatment Of Common Bile Duct Stones

Objective:Systematic evaluation of laparoscopic common bile duct exploration joint cholangioscopy lithotripsy(LCBDE) and open surgery(OCBDE) on patients with curative effect, a meta-analysis of the literatures. Methods:Using Chinese database includes WANFANG database, Chinese National Knowledge Infrastructure(CNKI), VIP database; English database includes Pub Med Central-NLM,Science Direct and Springer. the system retrieves information about laparoscopic common bile duct exploration joint cholangioscopy lithotomy surgery and open surgery for patients during operation and after the effect of randomized controlled trials. Retrieving years from January 2005 to December 2015, meet the entry criteria selected literature using Review Manager 5.3 system for statistical analysis, draw forest plot and funnel plot to operative time, blood loss, postoperative intestinal function recovery time, postoperative hospital stay as an indicator of the efficacy of two surgical comprehensive evaluation. Using odds ratio(OR value), weighted mean difference(WMD) and 95% Confidence interval(95% CI) for efficacy evaluation, the final results of the analysis order. Results:After screening 19 met the inclusion criteria, of which 17 Chinese reports and 2 English reports, a total of 2876 patients, including 1569 cases of laparoscopic common bile duct exploration group(LCBDE) and 1307 cases of open common bile duct exploration group(OCBDE). Meta-analysis showed that laparoscopy combined cholangioscopy choledocholithiasis more effective than open surgery.(1)In the age test for heterogeneity(P = 0.21), and male patients(P = 0.37), both P greater than 0.05, the difference was not statistically significant.(2)In terms of operation time, LCBDE group to be slightly shorter than OCBDE group, WMD equals-1.16,95% confidence interval(-7.51,5.19), P <0.05.(3)In terms of blood loss, LCBDE group less than OCBDE group, WMD equals-75.37,95% confidence interval(-97.1,-53.65), P <0.05.(4)In terms of bowel function recovery time, LCBDE group shorter than OCBDE group, WMD equals-20.62,95% confidence interval(-27.63~-13.61), P <0.05.(5)Postoperative hospital stay of LCBDE group shorter than OCBDE group, WMD equals-3.80,95% confidence interval(-5.06~-2.54), P <0.05.(6)The total length of hospital stay of LCBDE group less than OCBDE group, WMD equals-5.19,95% confidence interval(-6.42~-3.96), P <0.05. Conclusion:Compared with the two procedures, the overall efficacy of laparoscopic common bile duct exploration joint choledochoscopic lithotripsy is superior to open surgery, LCBDE ca n significantly reduce operative time,the amount of bleeding, patients with intestinal functi on recovery time,postoperative hospital stay and total hospital time.