Lucas Monteiro Delgado, Bernardo Fontel Pompeu, Eric Pasqualotto, Gabriel Henrique Acedo Martins, Clara de Jesus Moraes, Lucas Soares de Souza Pinto Guedes, Sergio Mazzola Poli de Figueiredo
{"title":"一期闭合与t管引流在胆总管探查治疗胆总管结石：最新的系统综述和荟萃分析。","authors":"Lucas Monteiro Delgado, Bernardo Fontel Pompeu, Eric Pasqualotto, Gabriel Henrique Acedo Martins, Clara de Jesus Moraes, Lucas Soares de Souza Pinto Guedes, Sergio Mazzola Poli de Figueiredo","doi":"10.1089/lap.2025.0048","DOIUrl":null,"url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Laparoscopic common bile duct exploration (LCBDE) is a critical procedure for managing choledocholithiasis, with primary closure (PC) and T-tube drainage (TTD) as common methods for common bile duct closure. However, the substantial number of new studies comparing PC and TTD underscores the need for an updated meta-analysis. Therefore, this study aims to compare surgery-related outcomes in PC and TTD for biliary duct closure following LCBDE. <b><i>Methods:</i></b> We searched PubMed, Embase, and Cochrane Library databases on June 20, 2024. Mean differences (MDs) and risk ratios with 95% confidence intervals (CIs) were pooled for continuous and binary outcomes, respectively. Heterogeneity was assessed with <i>I</i><sup>2</sup> statistics. Statistical analysis was performed using Software R, version 4.3.3. <b><i>Results:</i></b> A total of 31 studies comprising 4432 patients were included. A total of 2301 (51.9%) were submitted to PC and 2131 (48.1%) were submitted to TTD. The mean age of patients ranged from 39 to 69.8 years and 44.3% were male. Compared with TTD, PC significantly reduced retained stones (odds ratio [OR] 0.57; 95% CI 0.35-0.93; <i>P</i> = .02; <i>I</i><sup>2</sup> = 0%), biliary peritonitis (OR 0.22; 95% CI 0.08-0.60; <i>P <</i> .01; <i>I</i><sup>2</sup> = 0%), operative time (MD -21.07 minutes; 95% CI -27.68-14.46; <i>P <</i>. 01; <i>I</i><sup>2</sup> = 97%) and postoperative hospital stay (MD -2.20 days; 95% CI -2.80-1.60; <i>P <</i>. 01; <i>I</i><sup>2</sup> = 96%). However, there were no significant differences between the groups in recurrent stones (OR 0.57; 95% CI 0.32-1.02; <i>P</i> = .06; <i>I</i><sup>2</sup> = 0%), bile leakage (OR 0.89; 95% CI 0.65-1.23; <i>P</i> = .49; <i>I</i><sup>2</sup> = 0%), bile duct stricture (OR 2.08; 95% CI 0.36-12.11; <i>P</i> = .42; <i>I</i><sup>2</sup> = 0%), pneumonia (OR 1.38; 95% CI 0.66-2.88; <i>P</i> = .39; <i>I</i><sup>2</sup> = 0%), and pancreatitis (OR 0.64; 95% CI 0.29-1.38; <i>P</i> = .25; <i>I</i><sup>2</sup> = 0%). <b><i>Conclusion:</i></b> In this meta-analysis, PC was associated with decreased retained stones, biliary peritonitis, operative time, and postoperative hospital stay. However, no significant differences were observed for the other outcomes. These findings underscore PC as a safe and reliable method for bile duct closure following LCBDE.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"463-475"},"PeriodicalIF":1.1000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Primary Closure Versus T-Tube Drainage on Common Bile Duct Exploration for Choledocholithiasis: An Updated Systematic Review and Meta-Analysis.\",\"authors\":\"Lucas Monteiro Delgado, Bernardo Fontel Pompeu, Eric Pasqualotto, Gabriel Henrique Acedo Martins, Clara de Jesus Moraes, Lucas Soares de Souza Pinto Guedes, Sergio Mazzola Poli de Figueiredo\",\"doi\":\"10.1089/lap.2025.0048\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b><i>Introduction:</i></b> Laparoscopic common bile duct exploration (LCBDE) is a critical procedure for managing choledocholithiasis, with primary closure (PC) and T-tube drainage (TTD) as common methods for common bile duct closure. However, the substantial number of new studies comparing PC and TTD underscores the need for an updated meta-analysis. Therefore, this study aims to compare surgery-related outcomes in PC and TTD for biliary duct closure following LCBDE. <b><i>Methods:</i></b> We searched PubMed, Embase, and Cochrane Library databases on June 20, 2024. Mean differences (MDs) and risk ratios with 95% confidence intervals (CIs) were pooled for continuous and binary outcomes, respectively. Heterogeneity was assessed with <i>I</i><sup>2</sup> statistics. Statistical analysis was performed using Software R, version 4.3.3. <b><i>Results:</i></b> A total of 31 studies comprising 4432 patients were included. A total of 2301 (51.9%) were submitted to PC and 2131 (48.1%) were submitted to TTD. The mean age of patients ranged from 39 to 69.8 years and 44.3% were male. Compared with TTD, PC significantly reduced retained stones (odds ratio [OR] 0.57; 95% CI 0.35-0.93; <i>P</i> = .02; <i>I</i><sup>2</sup> = 0%), biliary peritonitis (OR 0.22; 95% CI 0.08-0.60; <i>P <</i> .01; <i>I</i><sup>2</sup> = 0%), operative time (MD -21.07 minutes; 95% CI -27.68-14.46; <i>P <</i>. 01; <i>I</i><sup>2</sup> = 97%) and postoperative hospital stay (MD -2.20 days; 95% CI -2.80-1.60; <i>P <</i>. 01; <i>I</i><sup>2</sup> = 96%). However, there were no significant differences between the groups in recurrent stones (OR 0.57; 95% CI 0.32-1.02; <i>P</i> = .06; <i>I</i><sup>2</sup> = 0%), bile leakage (OR 0.89; 95% CI 0.65-1.23; <i>P</i> = .49; <i>I</i><sup>2</sup> = 0%), bile duct stricture (OR 2.08; 95% CI 0.36-12.11; <i>P</i> = .42; <i>I</i><sup>2</sup> = 0%), pneumonia (OR 1.38; 95% CI 0.66-2.88; <i>P</i> = .39; <i>I</i><sup>2</sup> = 0%), and pancreatitis (OR 0.64; 95% CI 0.29-1.38; <i>P</i> = .25; <i>I</i><sup>2</sup> = 0%). <b><i>Conclusion:</i></b> In this meta-analysis, PC was associated with decreased retained stones, biliary peritonitis, operative time, and postoperative hospital stay. However, no significant differences were observed for the other outcomes. These findings underscore PC as a safe and reliable method for bile duct closure following LCBDE.</p>\",\"PeriodicalId\":50166,\"journal\":{\"name\":\"Journal of Laparoendoscopic & Advanced Surgical Techniques\",\"volume\":\" \",\"pages\":\"463-475\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Laparoendoscopic & Advanced Surgical Techniques\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1089/lap.2025.0048\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/5/5 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Laparoendoscopic & Advanced Surgical Techniques","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1089/lap.2025.0048","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/5 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
简介：腹腔镜胆总管探查（LCBDE）是治疗胆总管结石的关键手术，一期闭合（PC）和t管引流（TTD）是胆总管闭合的常用方法。然而，大量比较PC和TTD的新研究强调了更新元分析的必要性。因此，本研究旨在比较LCBDE术后PC和TTD胆管闭合的手术相关结果。方法：我们于2024年6月20日检索PubMed、Embase和Cochrane Library数据库。平均差异（MDs）和95%置信区间的风险比（ci）分别用于连续和二元结果的汇总。采用I2统计量评估异质性。采用R软件4.3.3版进行统计分析。结果：共纳入31项研究，4432例患者。共提交给PC 2301份（51.9%），提交给TTD 2131份（48.1%）。患者平均年龄39 ~ 69.8岁，男性44.3%。与TTD相比，PC显著减少了结石残留(优势比[OR] 0.57；95% ci 0.35-0.93；P = .02；I2 = 0%)，胆道性腹膜炎(OR 0.22；95% ci 0.08-0.60；P . 01;I2 = 0%)，手术时间(MD -21.07 min；95% ci -27.68-14.46；P。01;I2 = 97%)和术后住院时间(MD -2.20天；95% ci -2.80-1.60；P。01;I2 = 96%)。然而，两组间复发性结石发生率无显著差异(OR 0.57；95% ci 0.32-1.02；P = .06；I2 = 0%)，胆漏(OR 0.89；95% ci 0.65-1.23；P = .49；I2 = 0%)，胆管狭窄(OR 2.08；95% ci 0.36-12.11；P = .42；I2 = 0%)，肺炎(OR 1.38；95% ci 0.66-2.88；P = .39；I2 = 0%)和胰腺炎(OR 0.64；95% ci 0.29-1.38；P = .25；I2 = 0%)。结论：在这项荟萃分析中，PC与减少结石残留、胆道性腹膜炎、手术时间和术后住院时间有关。然而，其他结果没有观察到显著差异。这些发现强调了PC作为LCBDE后胆管闭合的安全可靠的方法。
Primary Closure Versus T-Tube Drainage on Common Bile Duct Exploration for Choledocholithiasis: An Updated Systematic Review and Meta-Analysis.
Introduction: Laparoscopic common bile duct exploration (LCBDE) is a critical procedure for managing choledocholithiasis, with primary closure (PC) and T-tube drainage (TTD) as common methods for common bile duct closure. However, the substantial number of new studies comparing PC and TTD underscores the need for an updated meta-analysis. Therefore, this study aims to compare surgery-related outcomes in PC and TTD for biliary duct closure following LCBDE. Methods: We searched PubMed, Embase, and Cochrane Library databases on June 20, 2024. Mean differences (MDs) and risk ratios with 95% confidence intervals (CIs) were pooled for continuous and binary outcomes, respectively. Heterogeneity was assessed with I2 statistics. Statistical analysis was performed using Software R, version 4.3.3. Results: A total of 31 studies comprising 4432 patients were included. A total of 2301 (51.9%) were submitted to PC and 2131 (48.1%) were submitted to TTD. The mean age of patients ranged from 39 to 69.8 years and 44.3% were male. Compared with TTD, PC significantly reduced retained stones (odds ratio [OR] 0.57; 95% CI 0.35-0.93; P = .02; I2 = 0%), biliary peritonitis (OR 0.22; 95% CI 0.08-0.60; P < .01; I2 = 0%), operative time (MD -21.07 minutes; 95% CI -27.68-14.46; P <. 01; I2 = 97%) and postoperative hospital stay (MD -2.20 days; 95% CI -2.80-1.60; P <. 01; I2 = 96%). However, there were no significant differences between the groups in recurrent stones (OR 0.57; 95% CI 0.32-1.02; P = .06; I2 = 0%), bile leakage (OR 0.89; 95% CI 0.65-1.23; P = .49; I2 = 0%), bile duct stricture (OR 2.08; 95% CI 0.36-12.11; P = .42; I2 = 0%), pneumonia (OR 1.38; 95% CI 0.66-2.88; P = .39; I2 = 0%), and pancreatitis (OR 0.64; 95% CI 0.29-1.38; P = .25; I2 = 0%). Conclusion: In this meta-analysis, PC was associated with decreased retained stones, biliary peritonitis, operative time, and postoperative hospital stay. However, no significant differences were observed for the other outcomes. These findings underscore PC as a safe and reliable method for bile duct closure following LCBDE.
期刊介绍：
Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST) is the leading international peer-reviewed journal for practicing surgeons who want to keep up with the latest thinking and advanced surgical technologies in laparoscopy, endoscopy, NOTES, and robotics. The Journal is ideally suited to surgeons who are early adopters of new technology and techniques. Recognizing that many new technologies and techniques have significant overlap with several surgical specialties, JLAST is the first journal to focus on these topics both in general and pediatric surgery, and includes other surgical subspecialties such as: urology, gynecologic surgery, thoracic surgery, and more.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
