The Meta-analysis Of Laparoscopic Hepatectomy Clinical Effect On Treatment Of Left Hepatolithiasis

Objective: To evaluate the safety and effectiveness of laparoscopichepatectomy and open hepatectomy in the treatment of left intrahepatic bile duct stone using the evidence-based medicine methods through domestic and foreign literature.The indexes include the operation time,intraoperative blood loss,length of stay,bile leakage and wound infection.Method:Use computer to retrieve the English database Pub Med,EMBASE and the Chinese database Wanfang Medical Database and China National Knowledge Internet(CNKI).The retrieval objects include randomized or semi-randomized controlled trials literature during from January,2000 to January,2017.The language types of the literature are English and Chinese.Two researchers,according to the inclusion and exclusion standards,determined the selection,abstracted the relevant materials and evaluated the literature quality.After the literature to be included are determined,use Rev Man 5.3 software for the Meta analysis.The number representation data is represented by odds ratio(OR)and 95% of the credibility interval and the measurement data is represented by the weighted mean difference(MD)and 95% of the credibility interval.The quality evaluation of the included literature uses the gauge made by the Jadad improved method.The score is 1-7 scores;1-3 scores are low quality research and 4-7 is high quality research.Result:At last,six articles were included,including five Chinese articles and one English article.There were 440 patients in the literature included(The open team and the laparoscope team both include 220 people).Compared with laparotomies,laparoscopic surgeries can reduce the intraoperative blood loss[MD=-54.76,95%CI(-108.96,-0.56),P=0.05],reduce the length of stay[MD=-3.52,95%CI(-5.08,-1.96),P<0.0001] and lower the incision infection rate[OR=0.11,95%CI(0.02,0.63),P=0.01<0.05].But,there is no obvious statistical difference of the incidence of the operation time[SMD=-0.97,95%CI(-2.06,0.13),P=0.08 > 0.05] andpostoperative bile leakage[OR=1.00,95%CI(0.27,3.77),P=1.00>0.05].Conclusion:Laparoscopic hepatectomy has shown better safety and efficacy in the treatment of intrahepatic bile duct stones.Laparoscopic hepatectomy can obviously shorten the operation time,reduce the intraoperative blood loss,length of stay and the incidence of postoperative wound infection.However,there is no obvious difference in terms of the occurrence of postoperative bile leakage.It is believed that with the advance of equipment and techniques,the advantages of laparoscopic hepatectomy will be more and more prominent.