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

被引：98
作者：
Lu, Jiong [1 ]
Cheng, Yao [1 ]
Xiong, Xian-Ze [1 ]
Lin, Yi-Xin [1 ]
Wu, Si-Jia [1 ]
Cheng, Nan-Sheng [1 ]
机构：
[1] Sichuan Univ, W China Hosp, Dept Bile Duct Surg, Chengdu 610041, Sichuan Provinc, Peoples R China
来源：
WORLD JOURNAL OF GASTROENTEROLOGY | 2012年 / 18卷 / 24期
关键词：
Laparoscopic cholecystectomy; Laparoscopic common bile duct exploration; Endoscopic retrograde cholangiopancreatography; Endoscopic sphincterotomy; Gallstones; Common bile duct stones; Meta-analysis; ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY; PROSPECTIVE RANDOMIZED-TRIAL; COST-EFFECTIVE MANAGEMENT; T-TUBE DRAINAGE; LAPAROSCOPIC CHOLECYSTECTOMY; COMPARING; 2-STAGE; RISK-FACTORS; EXPLORATION; CHOLANGIOGRAPHY; ERCP;
D O I：
10.3748/wjg.v18.i24.3156
中图分类号：
R57 [消化系及腹部疾病];
学科分类号：
摘要：
AIM: To evaluate the safety and effectiveness of two-stage vs single-stage management for concomitant gallstones and common bile duct stones. METHODS: 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 reviewers. The primary outcomes were stone clearance from the common bile duct, postoperative morbidity and mortality. The 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 scores. RESULTS: 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 analysis. The meta-analysis 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) management. CONCLUSION: Single-stage management is equivalent to two-stage management but requires fewer procedures. However, patient's condition, operator's expertise and local resources should be taken into account in making treatment decisions. (C) 2012 Baishideng. All rights reserved.
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页码：3156 / 3166
页数：11
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