| Purpose First,a Bayesian network meta-analysis was used to compare the efficacy and safety of three surgical approaches,open surgery（open cyst excision and Roux-enY hepaticojejunostomy）,laparoscopic surgery（laparoscopic cyst excision and Rouxen-Y hepaticojejunostomy）,robotic surgery（robotic cyst excision and Roux-en-Y hepaticojejunostomy）,for choledochal cyst in children and the best surgical approach is screened.Secondly,through clinical research,compare the efficacy of open surgery and laparoscopic surgery in the treatment of children with congenital choledochal cyst.Finally,the data from the clinical study is added to the previous part,and the network Meta-analysis is performed again to obtain the results,and judge whether the results of the two network meta-analyses are consistent.Methods（1）A network meta-analysis of open surgery,laparoscopic surgery,and robotic surgery for congenital choledochal cyst: we searched major Chinese and foreign databases（Chinese Biomedicine Literature Database,China National Knowledge Infrastructure,Wanfang Database,Pub Med,EMBASE,Cochrane Library,and Web of Science databases）.And literature search was completed in February 2022.The studies were screened according to the inclusion and exclusion criteria and the risk of bias for the cohort study enrolled in the systematic review and meta-analysis was assessed according to the Newcastle–Ottawa Scale（NOS）.We used Stata 14.0 software to carry out a Bayesian network meta-analysis and rank of the above three surgical approach.If there did not exist significant inconsistency,the consistency model based on a Bayesian model was used to pool data regarding to the relative outcomes;If there existed inconsistency,the direct evidence of the relative outcome was adopted and the statistical analyses were carried out by using Stata 14.0 software.We defined the primary outcomes as operation time,length of hospital stay,and intraoperative blood loss.The secondary outcomes measured were complications that included the number and rates of bile leakage,and intestinal obstruction after operation.A clinical study of open surgery and laparoscopic surgery in children with congenital choledochal cyst:First,the clinical data of children with congenital choledochal cyst who underwent surgery in Lanzhou University First Hospital from January 1,2010 to September 1,2021 were collected and children undergoing open surgery（open cyst excision and Roux-en-Y hepaticojejunostomy）,laparoscopic surgery（laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy）were included.Then,the data of the included children were entered and sorted in Excel form,and SPSS 22.0 software was used for statistical description and analysis of the data,to compare the efficacy of open surgery and laparoscopic surgery in the treatment of children with congenital choledochal cyst.Finally,the operation time,hospital stay,intraoperative blood loss,and rates of bile leakage and intestinal obstruction after operation collected from the clinical study were added to the previous part,and after the network meta-analysis was carried out again,the results of the network meta-analysis were obtained,which further verified the stability of the results of the previous part of the network meta-analysis.Result（1）A network meta-analysis of open surgery,laparoscopic surgery,and robotic surgery for congenital choledochal cyst: Twenty-eight cohort studies（3672children）were finally included,and the publication time was from 2007 to 2021.Two studies were three arms,and the remaining 26 studies were two arms.9 cohort studies clearly stated that the non-exposed group and the exposed group were from different populations,while 1 cohort study did not describe the source of the non-exposed group,so these 10 cohort studies received 0 points in the item of selection of the non-exposed cohort;3 cohorts studies received 0 points in the item of Comparability;10 cohort studies received 0 points in the item of being follow-up long enough for outcomes to occur.15 studies reported the operation time,because there existed inconsistency,the direct evidence of the relative outcome was adopted.13 studies compared the operative time between open surgery and laparoscopic surgery,and the operative time of open surgery was shorter than that of laparoscopic surgery [direct estimate MD=-1.101,95%CI（-1.368,-0.834）],three studies compared the operative time between robotic surgery and laparoscopic surgery,and the operative time of robotic surgery was shorter than that of laparoscopic surgery [direct estimate MD=0.56,95%CI（-0.65,-0.47）] and3 studies compared the operative time between open surgery and robotic surgery,and the operative time of open surgery was shorter than that of robotic surgery [direct estimate MD=-1.39,95%CI（-1.69,-1.09）];A total of 18 cohort studies reported length of stay as an outcome measure,and there was no inconsistency,compared with robotic surgery,laparoscopic surgery [network estimate MD=1.02,95%CI（-0.11,2.16）]and open surgery [network estimate MD=3.01,95%CI（1.76,4.2）] had longer hospital stays,and compared with open surgery,laparoscopic surgery had shorter hospital stays[network estimate MD=-1.98,95%CI（-2.72,-1.19）];13 studies reported intraoperative blood loss as an outcome indicator,and there was no inconsistency,compared with laparoscopic surgery,robotic surgery [network estimate MD=1.55,95%CI（-56.59,59.51）] and open surgery [network estimate MD=46.76,95%CI（10.36,83.64）] had more intraoperative blood loss,and compared with open surgery,robotic surgery had less intraoperative bleeding loss [network estimate MD=-45.15,95%CI（-108.38,17.26）];16 studies reported the incidence of postoperative bile leakage,and there was no inconsistency,compared with robotic surgery,laparoscopic surgery [network estimate OR=9.27,95%CI（0.29,1071.68）] and open surgery [network estimate OR=4.97,95%CI（0.15,457.94）] had a higher incidence of postoperative bile leakage,and compared with open surgery,laparoscopic surgery had a higher incidence of postoperative bile leakage [network estimate OR=1.86,95%CI（0.38,11.32）];Nine studies reported the incidence of postoperative ileus,and there was no inconsistency,compared with laparoscopic surgery,the incidence of postoperative ileus of robotic surgery was higher [network estimate OR=18.82,95%CI（0.88,655.51）],and the incidence of ileus after laparoscopic surgery was lower than that of open surgery[network estimate OR=0.11,95%CI（0.01,0.6）],and compared with robotic surgery,the incidence of intestinal obstruction was lower after open surgery [network estimate OR= 0.48,95%CI（0.03,8.58）].（2）A clinical study of open surgery and laparoscopic surgery in children with congenital choledochal cyst: The operation time of the open group was（3.52±0.82）hours,which was shorter than that of the laparoscopic group（5.61±1.24）hours,and there was a statistical difference between the two（p<0.01）,the hospital stay in the open group was（15.98±4.99）days,which was longer than that in the laparoscopy group（12.92±2.15）days,and there was a statistical difference between the two（p<0.05）,the intraoperative blood loss in the open group was（90.45 ± 62.29）ml,which was more than that in the laparoscopy group（46.00 ± 26.52）ml;There was a statistical difference between the two（p < 0.05）,4 cases（6.67%）of complications occurred in the open group,including 1 incision infection（1.67%）,1 case of postoperative bile leakage（1.67%）,2 cases of postoperative intestinal obstruction（3.33%）,there were no complications in the laparoscopy group such as incision infection,postoperative biliary leakage and postoperative ileus,and there were no statistically significant differences in the incidence of incision infection,postoperative biliary leakage,and postoperative ileus between the open group and the laparoscopic group;The results of the network meta-analysis after adding the data of this part of the clinical study were consistent with the results of the second part of the network metaanalysis.Conclusion（1）Compared with the other two surgical methods,open surgery has the shortest operation time,but the longest hospital stay and the largest intraoperative blood loss;laparoscopic surgery,although the longest operation time,has the lowest incidence of intestinal obstruction in children;Although robot surgery the operation has the shortest hospital stay and the lowest incidence of postoperative bile leakage,its incidence of postoperative intestinal obstruction is the highest in children.（2）The hospitalization time and intraoperative blood loss of the children in the laparoscopic group were less than those in the open group;the operation time of the children in the laparoscopic group was longer than that of the children in the open group;There was no difference in the incidence of incision infection,postoperative bile leakage,and postoperative intestinal obstruction between the two groups. |
PDF Full Text Request