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Two-stage vs single-stage management for concomitant gallstones and common bile duct stones

World Journal of Gastroenterology 2012年第24期18卷 3156-3166页

作者： Jiong Lu Yao Cheng Xian-Ze Xiong Yi-Xin Lin Si-Jia Wu Nan-Sheng Cheng Department of bile duct Surgery West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina

AIM:To evaluate the safety and effectiveness of twostage vs single-stage management for concomitant gallstones and common bile duct ***:Four databases,including PubMed,Embase,the Cochrane Central Register of Controlled Trials and the Science Citation Index up to September 2011,were searched to identify all randomized controlled trials(RCTs).Data were extracted from the studies by two independent *** primary outcomes were stone clearance from the common bile duct,postoperative morbidity and *** secondary outcomes were conversion to other procedures,number of procedures per patient,length of hospital stay,total operative time,hospitalization charges,patient acceptance and quality of life ***:Seven eligible RCTs [five trials(n = 621) comparing preoperative endoscopic retrograde cholangiopancreatography(ERCP)/endoscopic sphincterotomy(EST) + laparoscopic cholecystectomy(LC) with LC + laparoscopic common bile duct exploration(LCBDE);two trials(n = 166) comparing postoperative ERCP/EST + LC with LC + LCBDE],composed of 787 patients in total,were included in the final *** metaanalysis detected no statistically significant difference between the two groups in stone clearance from the common bile duct [risk ratios(RR) =-0.10,95% confidence intervals(CI):-0.24 to 0.04,P = 0.17],postoperative morbidity(RR = 0.79,95% CI:0.58 to 1.10,P = 0.16),mortality(RR = 2.19,95% CI:0.33 to 14.67,P = 0.42),conversion to other procedures(RR = 1.21,95% CI:0.54 to 2.70,P = 0.39),length of hospital stay(MD = 0.99,95% CI:-1.59 to 3.57,P = 0.45),total operative time(MD = 12.14,95% CI:-1.83 to 26.10,P = 0.09).Two-stage(LC + ERCP/EST) management clearly required more procedures per patient than single-stage(LC + LCBDE) ***:Single-stage management is equivalent to two-stage management but requires fewer ***,patient's condition,operator's expertise and local resources should be taken into account in making treatment de

关键词： laparoscopic cholecystectomy laparoscop-ic common bile duct exploration Endoscopic retrogradecholangiopancreatography Endoscopic sphincterotomy Gallstones common bile duct stones Meta-analysis

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