关键词: 胆囊结石病, 胆总管结石, 胆总管探查术, 腹腔镜检查, 括约肌切开术, 内窥镜, Meta分析

Abstract: Background　Cholecystolithiasis complicated with choledocholithias is a common disease in clinical medication.One-stage Laparoscopic common bile duct exploration（LCBDE） + laparoscopic cholecystectomy（LC） and sequential two-stage endoscopic retrograde cholangiopancreatography（ERCP）/endoscopic sphincterotomy（EST） + LC are both accepted as ideal minimally invasive treatment methods，some domastic and foreign scholars have analyzed and compared the advantages and disadvantages of the two methods，but which method is more advantagous still remains uncertain．Objective　To compare the efficacy and safety of one-stage LCBDE+LC and sequential two-stage ERCP/EST +LC in the treatment of cholecystolithiasis complicated with choledocholithiasis．Methods　Randomized controlled trials（RCTs） comparing the efficacy of one-stage LCBDE+LC and sequential two-stage ERCP/EST+LC were searched from the database including PubMed，EMBase，Web of Science，The Cochrane Library，CNKI and WanFang Data Service Platform from January 2009 to March 2020．The first author's name，country，publishing time，time period of the patients，sample number，age，ratio of female，ratio of multiple stones，common bile duct diameter，ASA grade，follow-up period，outcome indexes（the common bile duct calculi clearance ratio，incidence of postoperative complications，surgical transferation ratio，bile leakage ratio，incidence of pancreatitis，residual stone ratio，calculi recurrence ratio，hospitalization fee，length of hospitalization stay，operation time） were recorde．Meta-analysis was performed using RevMan 5.3 software．Results　A total of 20 RCTs were included in this study，and the overall quality of the literatures was good．Choledoch stone clearance ratio 〔OR=1.11，95%CI（0.78，1.58），P=0.55〕，surgical transferance ratio 〔OR=1.11，95%CI（0.64，1.93），P=0.71〕，residual stone ratio 〔OR=0.73，95%CI（0.45，1.19），P=0.21〕，length of hospitalization stay 〔SWD=-0.43，95%CI（-0.87，0.02），P=0.06〕 and operation time 〔SWD=-0.28，95%CI（-1.09，0.53），P=0.50〕 showed no significant differences between the one-stage LCBDE+LC group and sequential two-stage ERCP/EST+LC group．Compared with the sequential two-stage ERCP/EST+LC group，postoperative complication ratio 〔OR=0.57，95%CI（0.43，0.75），P<0.000 1〕，stone recurrence ratio〔OR=0.33，95%CI（0.16，0.69），P=0.003〕，hospitalization cost 〔SWD=-1.07，95%CI（-1.44，-0.69），P<0.000 01〕，pancreatitis ratio 〔OR=0.13，95%CI（0.06，0.27），P<0.000 01〕 significantly decreased，while the bile leakage ratio 〔OR=3.68，95%CI（2.10，6.45），P<0.000 01〕 significantly increased in the one-stage LCBDE+LC group．Conclusion　Compared with sequential two-stage ERCP/EST+LC，one-stage LCBDE+LC showed lower incidence of total complications，stone recurrence ratio and hospitalization cost，but showed obvious advantages in perioperative safety．There were no significant differences in the stone clearance ratio，operation time，length of hospitalization stay，surgical transferance ratio and residual stone ratio between the two groups．

Key words: Cholecystolithiasis, Choledocholithiasis, Common bile duct exploration, Laparoscopy, Sphincterotomy, Endoscope, Meta analysis