| Background and purpose:Cholelithiasis is a common clinical disease,and the number of patients continues to increase.The main treatment for cholecystolithiasis with choledocholithiasis is laparoscopic cholecystectomy,but the optimal treatment is still controversial.LC+LCBDE and LC+ERCP are the main clinical choices,but the treatment methods have their own advantages and disadvantages and are controversial.Based on a large number of studies at our country and abroad,this study conducted a meta-analysis on the effectiveness and safety of LC+LCBDE and LC+ERCP in the treatment of cholecystolithiasis combined with choledocholithiasis,hoping to provide strong help for clinical treatment of cholecystolithiasis combined with choledocholithiasis,and select appropriate treatment plans according to the development of the disease and the patient’s own physical condition.method:Use the computer to search CNKI,Wanfang,CBM,VIP and other databases,mainly search for relevant articles about cholecystolithiasis combined with choledocholithiasis,and search the literature according to the inclusion criteria to ensure the quality and research content of the relevant literature.The search time will end in 2021,and extract the author of the retrieved literature,the time of publishing the literature,the number of samples,the time of treatment,the time of surgery,the number of days in hospital The operation effect,postoperative complications and other indicators were statistically analyzed.The data were collected using Excel and meta-analysis.result:A total of 1421 articles were retrieved in this study,and 18 articles were finally included.One of them did not elaborate on the scheme generated by random sequence,so it was classified as risk uncertainty;There are 7 articles describing allocation hiding.All literatures did not describe the specific implementation method of blind selection,mainly because such intervention was surgical intervention,so it was evaluated as uncertain risk.No selective report or other bias was found in 18 articles.The stone clearance rate was calculated in the form of standard deviation,OR=1.05,95% CI=0.80-1.40.P>0.05,indicating that there was no statistical significance in stone clearance rate between the two surgical methods;The residual rate of stones was calculated in the form of standard deviation,OR=0.61,95%CI=0.36-1.03。P>0.05,indicating that there was no statistical significance in the residual rate of stones between the two surgical methods;The conversion laparotomy rate was calculated in the form of standard deviation,OR=0.93,95% CI=0.50-1.70.P>0.05,indicating that there was no statistical significance in the conversion rate between the two surgical methods;The incidence rate of postoperative bile leakage was calculated in the form of standard deviation,OR=0.20,95% CI=0.11-0.41.P < 0.05,there was statistical significance in the incidence of bile leakage between the two surgical methods,indicating that the incidence of bile leakage after LC+LCBDE was higher than that of ERCP+LC;The incidence of postoperative pancreatitis was calculated in the form of standard deviation,OR=0.532,95% CI=2.70-10.57.P < 0.05,indicating that the difference in the incidence of postoperative pancreatitis between the two surgical methods is statistically significant,and the incidence of pancreatitis after LC+LCBDE is lower than that of ERCP+LC;The incidence of postoperative biliary bleeding was calculated in the form of standard deviation,OR=4.15,95% CI=1.90-9.07.P<0.05,indicating that there was statistical significance in the incidence of postoperative biliary bleeding between the two surgical methods.The incidence of postoperative biliary bleeding after LC+LCBDE was lower than that of ERCP+LC;Postoperative abdominal infection was counted by standard deviation,OR=40.56,95%CI=10.29-1.08.P>0.05,indicating that there was no statistical significance in the incidence of postoperative abdominal infection between the two surgical methods;The operation time was counted in the form of standard deviation,OR=-0.29,95%CI=-1.08-0.52.P>0.05,indicating that there is no statistical significance between the two surgical methods in terms of operation time;The hospitalization time was counted in the form of standard deviation,OR=40.56,95% CI=10.29-91.08.P<0.05,indicating that there was statistical significance between the two surgical methods in hospital stay;The total hospitalization expenses were calculated in the form of standard deviation,OR=0.38,95%CI=0.07--0.85.P<0.05,indicating that the difference between the two groups in the total cost of hospitalization is statistically significant,and the total cost of LC+LCBDE is lower than that of ERCP+LC.Conclusion:LC+LCBDE and ERCP+LC have some similarities in stone clearance rate,stone residue rate,conversion to laparotomy rate and operation time,indicating that the two types of operations are equivalent in this respect;Among them,bile leakage is the main complication after LC+LCBDE,and pancreatitis is the main complication after ERCP+LC.The incidence of biliary bleeding after ERCP+LC is higher than that of LC+LCBDE,the hospitalization cost and hospital stay of ERCP+LC is higher. |
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