外科理论与实践

外科理论与实践 >

2025 , Vol. 30 >Issue 2: 151 - 158

DOI: https://doi.org/10.16139/j.1007-9610.2025.02.10

论著

腹腔镜胆总管探查取石联合胆囊切除术后一期缝合与T管引流临床疗效比较的荟萃分析

  • 王平 ,
  • 包卉 ,
  • 宋振顺
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  • 1.泰州市第四人民医院 a.肝胆胰外科, b.心血管内科，江苏 泰州 225300
    2.同济大学附属上海市第四人民医院 肝胆胰外科，上海 200434
宋振顺，E-mail：zs_song@tongji.edu.cn

收稿日期: 2024-05-15

  网络出版日期: 2025-07-07

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Meta-analysis of comparative clinical outcomes between primary closure and T-tube drainage following laparoscopic common bile duct exploration and extraction combined with cholecystectomy

  • WANG Ping ,
  • BAO Hui ,
  • SONG Zhenshun
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  • 1a. Department of Hepato-Biliary-Pancreatic Surgery, b. Department of Cardiovascular Medicine, Taizhou Fourth People's Hospital, Jiangsu Taizhou225300,China
    2. Department of Hepatobiliary and Pancreatic Surgery, Shanghai Fourth People's Hospital affiliated to Tongji University, Shanghai 200434, China

Received date: 2024-05-15

  Online published: 2025-07-07

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摘要

目的: 系统评价腹腔镜下胆总管探查取石联合胆囊切除术后一期缝合与T管引流两种胆总管闭合方式在治疗胆总管结石合并胆囊结石的优缺点。方法: 通过计算机检索PubMed、中国期刊全文数据库、中国万方数据库、中国维普数据库等，检索时间2012年1月1日至2021年12月31日，按照纳入及排除标准筛选研究文献，采用Review Manager 5.4软件进行荟萃分析。结果: 共纳入10篇文献，收集1 589例病人，其中一期缝合组783例，T管引流组806例。荟萃分析结果显示：一期缝合能缩短手术时间[MD=-15.59，95%CI：（-23.74，-7.45），P=0.000 2]，减少手术中出血量[MD=-6.49，95%CI：（-12.74，-0.24），P=0.04]，提早恢复胃肠道功能[MD=-0.39，95%CI：（-0.60，-0.19），P=0.000 2]，减少术后住院时间[MD=-1.41，95%CI：（-2.19，-0.62），P=0.000 4]，减少住院费用[SMD=-0.66，95%CI：（-1.21，-0.12），P=0.02]。结论: 两种胆总管闭合方式在治疗胆总管结石合并胆囊结石都是安全有效的。但一期缝合组相比于T管引流组，具有手术时间短、术中出血量少、术后住院时间短、住院费用低等优点，值得临床推广。

关键词： 胆总管结石; 腹腔镜胆总管探查取石; 一期缝合; T管引流

本文引用格式

王平 , 包卉 , 宋振顺 . 腹腔镜胆总管探查取石联合胆囊切除术后一期缝合与T管引流临床疗效比较的荟萃分析[J]. 外科理论与实践, 2025 , 30(2) : 151 -158 . DOI: 10.16139/j.1007-9610.2025.02.10

Abstract

Objective To systematically evaluate the comparative efficacy of primary closure versus T-tube drainage following laparoscopic common bile duct exploration (LCBDE) and extraction combined with cholecystectomy in the management of choledocholithiasis with concomitant cholecystolithiasis.Methods A comprehensive search of databases including PubMed, CNKI, Wanfang, and VIP was conducted from January 1, 2012, to December 31, 2021. Eligible studies were screened based on predefined inclusion/exclusion criteria, and meta-analysis was performed using Review Manager 5.4 software.Results Ten studies involving 1 589 patients (783 primary closure vs. 806 T-tube drainage) were included. Meta-analysis demonstrated that primary closure significantly reduced operation time [MD = -15.59, 95% CI: (-23.74, -7.45), P = 0.000 2], intraoperative blood loss [MD = -6.49, 95% CI: (-12.74, -0.24), P = 0.04], postoperative gastrointestinal recovery time [MD = -0.39, 95% CI: (-0.60, -0.19), P= 0.000 2], postoperative hospital stay [MD = -1.41, 95% CI: (-2.19, -0.62), P = 0.000 4], and hospitalization costs [SMD = -0.66, 95% CI: (-1.21, -0.12), P = 0.02].Conclusions Both closure methods are safe and effective for choledocholithiasis with cholecystolithiasis. However, primary closure offers advantages including shorter operative duration, reduced blood loss, decreased hospital stay, and lower costs, warranting broader clinical adoption.

Key words： Common bile duct stone; Laparoscopic common bile duct exploration(LCBDE) and extraction; Primary closure（PC）; T-tube drainage(TD)

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