Meta-analysis Of Factors Related To Biliary Tract Injury In Laparoscopic Cholecystectomy

Objective:Laparoscopic cholecystectomy has become the "gold standard" operation for the treatment of cholecystitis due to its absolute advantages of small trauma and fast postoperative recovery.However,biliary tract injury is still recognized as one of the serious complications of laparoscopic cholecystectomy due to its characteristics of acute onset and critical condition,causing serious harm to the health and life safety of patients.The purpose of this study was to explore the risk factors associated with biliary tract injury in laparoscopic cholecystectomy,so as to deepen the understanding of biliary tract injury and hopefully to guide clinical practice.Methods:Retrieval of relevant Chinese and English journals and literatures by computer in PubMed,Web of science,Cochrane Library,VIP,wanfang,CNKI and other databases.Literature in English and Chinese on the study of biliary tract injury in laparoscopic cholecystectomy published at home and abroad up to December 2019 was collected.The quality of the literature was evaluated according to the Newcastle-Ottawa scale(NOS),and the relevant risk factors were statistically analyzed with RevMan 5.3 to obtain a reliable estimate of the relevant factors of biliary tract injury.Results:After strict screening,a total of 29 domestic and foreign related studies were included.Meta analysis was performed on 14 risk factors,suggesting that:acutecholecystitis,a higher likelihood of biliary injury(p < 0.0001),and/OR 4.25(2.04,8.84),biliary anatomy anomalies a higher likelihood of biliary injury(p < 0.00001),[OR 11.28(5.09,25.02)],gallbladder wall thickening of the possibility of biliary injury is higher(p< 0.0001),[OR 5.06(3.18,8.05)],intraoperative adhesion a higher likelihood of biliary injury(p < 0.0001),and/OR 6.35(2.84,14.19),and a higher likelihood of biliary injury intraoperatie bleeding(p < 0.0001),and/OR 7.63(4.62,12.58),first cut off the gallbladder is in charge of a higher likelihood of biliary injury(p < 0.0001),[OR 8.06(3.20,20.32)],Men a higher likelihood of biliary injury(p = 0.03),and/OR 0.67(0.47,0.97)is a risk factor for bile duct injury of laparoscopic cholecystectomy.Preoperative training a lower likelihood of biliary injury(p < 0.00001),and/OR 0.17(0.10,0.28),the doctor learning curve for the possibility of biliary injury is lower(p < 0.00001),and/OR0.25(0.14,0.44),preoperative MRCP,a lower likelihood of biliary injury(p < 0.0001),and/OR 0.14(0.05,0.36)and biliary imaging a lower likelihood of biliary injury(p <0.00001),[OR 0.08(0.03,0.21)] were all protective factors of biliary tract injury in laparoscopic cholecystectomy.There was no significant correlation between age and biliary tract injury(P=0.09),no significant correlation between emergency surgery and biliary tract injury(P=0.24),and no significant correlation between operation time and biliary tract injury(P=0.30).Conclusion:Acute cholecystitis,abnormal biliary tract anatomy,thickening of gallbladder wall,intraoperative adhesion,intraoperative hemorrhage,and cutting off the gallbladder duct first,male are risk factors for biliary tract injury in laparoscopic cholecystectomy.Preoperative training,doctor's learning curve,preoperative MRCP and intraoperative cholangiography are all protective factors for biliary tract injury in laparoscopic cholecystectomy.Age,emergency operation and operation time had little correlation with biliary tract injury.