目的    评价腹腔镜胆囊切除联合腹腔镜胆总管探查术(LC+LCBDE)与内镜下十二指肠乳头括约肌切开取石联合腹腔镜胆囊切除术（ERCP/S+LC）治疗胆囊结石合并胆总管结石的临床疗效差异。方法    通过PubMed、Cochrane 图书馆、MEDLINE、EMBase等数据库，查找发表于1998年1月至2012年12月关于对比分析LC+LCBDE与ERCP/S+LC治疗胆囊结石并胆总管结石的随机对照试验研究，按照纳入与排除标准选择文献、提取资料、评价质量后，采用RevMan5.0软件进行数据分析。结果    共有9篇研究纳入分析，包括1247例病人，其中LC+LCBDE组570例，ERCP/S+LC组497例。结果显示：结石清除率、结石残留率、术后总并发症发生率、病死率、术中转开腹率差异无统计学意义［（RR:0.97，95% CI: 0.93～1.02，P=0.24）、（OR:0.46，95% CI: 0.13～0.62，P=0.23）、（OR:0.89，95% CI: 0.63～1.26，P=0.51）、（RD:0.00，95% CI: -0.01～0.02，P=0.54）、（OR:0.71，95% CI: 0.45～1.12，P=0.15）］；手术时间、住院时间、住院费用LC+LCBDE组优于ERCP/S+LC组。结论    LC+LCBDE与ERCP/S+LC两种微创术式有效性及安全性无差异，但前者手术时间、住院时间、住院费用优于后者，可能与ERCP/S+LC分阶段手术有关，需要更多高质量的前瞻性随机对照研究提供更好的证据。

Laparoscopic cholecystectomy combined with endoscopic retrograde cholangiopancreatography vs laparoscopic common bile duct exploration in the treatment of concomitant gallstones and common bile duct stones: A meta analysis        TIAN Kai-liang, ZHU Li-xin, XIE Kun, et al. Center of Organ Transplantation, First Affiliated Hospital of Anhui Medical University, Hefei230032, China
Corresponding author: ZHU Li-xin, E-mail: lx-zhu@163.com
Abstract    Objective    To evaluate the clinical effectiveness of LC+LCBDE and ERCP/S+LC in cholecystolithiasis choledocholithiasis using meta-analysis method. Methods    A fully recursive literature search was conducted in MEDLINE，PubMed，EMbase，Cochrane Central Registe of Controlled Trials only in English, comparing LC+LCBDE with ERCP/S+LC for cholecystolithiasis choledocholithiasis and published from 1998 to 2012 were recruited. Data were extracted and evaluated by two reviewers independently. The quality of the included trials was evaluated. Meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.1 software. Results    Nine controlled clinical trials (1247 cases) were included. The results of meta-analysis showed that: there were no significant difference in the stone clearance rate，residual stone rate，complications morbidity，mortality，cross over to other procedure between the two group [(RR:0.97, 95% CI: 0.93—1.02, P=0.24), (OR:0.46, 95% CI: 0.13—0.62, P=0.23), (OR:0.89, 95% CI: 0.63—1.26，P=0.51), (RD:0.00, 95% CI: -0.01—0.02, P=0.54), (OR:0.71, 95% CI: 0.45—1.12, P=0.15)]; the length of hospital stay, procedure time and total hospital charges in the LC+LCBDE group were superior to the ERCP/S+LC group. Conclusion    Although there aren’t differences in the effectiveness and safety between the ERCP/S+LC group and the LC+LCBDE group, the latter is superior to the former in procedure time, length of hospital stay and total hospital charges, which might be associated with ERCP/S+LC surgery in stages. It needs more prospective randomized controlled studies with high quality to provide better evidences.