| [Objective]:To evaluate the clinical outcomes of primary duct closuere and T-tube drainage placement after Laparoscopic common bile duct exploration and choledocholihotomy by Meta-anlysis.[Methods]:Literature search include databases:CHKD, PubMed, CBM, Wanfang Data, FMJS, FEBM (from 2005 to Dec,2015) screened for clinical trials of primary closure and T-tube drainage after laparoscopic common bile duct exploration. Their references was also searched. A systematic screen was performed based on the included studies and the quality was evaluated.The data comprised operative time, bleeding volume, postoperative hospital stay, resumptions of gastrointestinal function, postoperative complications(bile leakage, residual stones, bile duct stricture, biliary peritonitis, incision infection,) were extracted and then RevMan5.3 software from Cochrane Collaboration was used for data analysis.[Results]:Six clinical trials with a total of 769 cases were included in this article. The results of meta-analysis showed that the primary closure had significant lower operative time (WMD 95%CI,-17.44[-27.83,-7.06],P<0.00001), bleeding volume (WMD 95%CI,-0.54[-0.97,-0.10],P=0.02), postoperative hospital stay (WMD 95%CI,-3.06[-3.23,-2.89],P<0.00001) and resumptions of gastrointestinal function (WMD 95%CI,-14.00[-20.90,-7.09],P<0.0001) compared with the T-tube drainage group. There was no significant difference between the two groups regarding the bile leakage (OR=1.15,95%CI:0.54-2.44,P=0.72), residual stones (OR=0.79, 95% CI:0.33-1.89,P=0.60), bile duct stricture (OR=0.58,95%CI:0.08- 4.53,P=0.61), biliary peritonitis (OR=0.22,95%CI:0.04-1.30,P=0.10), incision infection (OR=0.25,95%CI:0.04-1.53,P=0.13)[Conclusion]:From the current data, primary closure group after Laparoscopic common bile duct exploration showed much advantage over T-tube drainage group on operative time, bleeding volume, resumptions of gastrointestinal function, postoperative hospital stay. And there was no significant difference between the two group regarding postoperative complications(bile leakage, residual stones, bile duct stricture, biliary peritonitis, incision infection).Therefore, primary closure group after Laparoscopic common bile duct exploration is of great application value. However, Due to the low diversity and limited quality of the included literature and the shortage of randomized controlled trials from multi-center, large sample of randomized controlled trials from multi-centers need to be provided to further prove the conclusion. |
