Literature screening process and the basic characteristics of the literature
This study has been included in 21 RCT studies. The document screening process is shown in Figure 1. There are 12 English literatures and 9 Chinese literature, from 9 countries. The sample samples of the "one -step method" and the "two -step method" group were 1376 cases and 1374 cases; Jadad scored 2 ~ 6 points, 14 points ≥4, accounting for 66.7%; ending indicators: 13 documents reported CBD Qingqing Qingqing Stone rate, 12 documents reported the opening rate of the transfer, 12 documents reported the stones residual rate, 6 documents reported the recurrence rate of stones, 21 documents reported the occurrence of complications, 15 documents reported the postoperative hospital hospitalization time Essence, (Table 1).
Table 1 incorporate the basic characteristics of the literature
Author
|
Year
|
country
|
Cases
|
|
Age
|
outcom
|
Jadad
|
|
|
|
T
|
C
|
|
T
|
C
|
|
|
Bansal vk [8]
|
2010
|
India
|
15
|
15
|
|
47.1
|
39.1
|
|
5
|
Ding gq [9]
|
2014
|
China
|
110
|
111
|
|
58.4
|
57.5
|
|
4
|
Noble H [10]
|
2009
|
UK
|
47
|
44
|
|
75.9
|
74.3
|
|
4
|
Koc B [11]
|
2013
|
Turkey
|
57
|
54
|
|
51.5
|
54.9
|
|
2
|
Rogers sj [12]
|
2010
|
USA
|
17
|
31
|
|
39.93
|
44.6
|
|
6
|
González jeb [13]
|
2016
|
CUBA
|
43
|
45
|
|
56.3
|
57.7
|
|
3
|
Ferulano GP [14]
|
2011
|
Italy
|
45
|
39
|
|
53
|
55
|
|
4
|
Lu j [15]
|
2013
|
China
|
88
|
122
|
|
49.5
|
52.1
|
|
3
|
Elgeidie aa [16]
|
2011
|
Egypt
|
112
|
107
|
|
32.5
|
29.2
|
|
5
|
Poh br [17]
|
2016
|
Australia
|
52
|
52
|
|
53.4
|
53.9
|
|
6
|
Liu s [18]
|
2020
|
China
|
104
|
103
|
|
56.9
|
57.1
|
|
5
|
Aldardeer Aak [19]
|
2019
|
Egypt
|
75
|
75
|
|
—
|
—
|
|
3
|
Yue dc [20]
|
2016
|
China
|
106
|
108
|
|
59.8
|
57.0
|
|
3
|
Dai gq [21]
|
2010
|
China
|
72
|
60
|
|
53.7
|
54.9
|
|
3
|
Li jf [22]
|
2020
|
China
|
53
|
53
|
|
68.1
|
68.1
|
|
4
|
Shu cx [23]
|
2018
|
China
|
49
|
49
|
|
69.0
|
67.3
|
|
5
|
Yang rg [24]
|
2017
|
China
|
51
|
49
|
|
54.5
|
53.9
|
|
4
|
Luo H [25]
|
2018
|
China
|
45
|
55
|
|
63.7
|
69.8
|
|
6
|
Ma dx [26]
|
2016
|
China
|
58
|
56
|
|
62.1
|
59.4
|
|
4
|
Fng H [27]
|
2021
|
China
|
87
|
65
|
|
—
|
—
|
|
4
|
Wang gt [28]
|
2020
|
China
|
90
|
81
|
|
49.2
|
53.3
|
|
2
|
Meta analysis results
CBD Qingshi Rate 13 documents reported the CBD Qingshi rate. The results of the random effect model META analysis showed that there was no significant difference in the "one -step method" and the "two -step method" CBD Qingshi rate (OR = 1.03, 95%CI Intersection 0.58, 1.81), as shown in Figure 2.
Transfer opening rate 12 documents Report the transit opening rate. The analysis of the fixed effect model META shows that there is no statistical difference in the opening rate in different groups (OR = 0.78, 95%CI: 0.49, 1.25), as shown in Figure 3.
Stone residue 12 documents report the stones residual rate. The results of the random effect model META analysis show that there is no statistical difference in the stones residue rate of different groups (OR = 0.73, 95%CI: 0.34, 1.56), as shown in Figure 4.
The recurrence rate of stones 6 articles reported the recurrence rate of stones. The analysis of the fixed effect model META showed that the "one -step method" of the "one -step method" was significantly lower than the "two -step method" (or = 0.37, 95%CI: 0.20, 0.69), as shown in Figure 5.
Postoperative complications 19 documents reported the total incidence of postoperative complications, and the analysis of the fixed effect model META analysis showed that the total incidence of complications of "one -step method" was lower than the "two -step method" 95%CI: 0.52, 0.84), as shown in Figure 6. Common complications analysis results show that the incidence of bile leakage in the "one-step method" is higher than the "two-step method" (or = 3.10, 95%CI: 1.77, 5.42), biliary bleeding (OR = 0.28, 95%CI: 0.12, 0.65), bile ductitis (or = 0.25, 95%CI: 0.11, 0.56) and pancreatitis (or = 0.19, 95%CI: 0.12, 0.32) The incidence rate is lower than the "two-step method", as shown in Figures 7, Figure 9, Figure 10, and Figure 11; there is no significant difference in the occurrence rate of abdominal cavity infection/incision infection (P> 0.05), as shown in Figure 8.
After surgery, 15 documents reported the postoperative hospitalization time. The results of the random effect model META analysis showed that the "one-step method" was significantly shorter after the operation of the operation (WMD = -1.07D, 95%CI: -2.00,- 0.14), as shown in Figure 12.
The results of the EGGER inspection of bias show that the CBD Qingshi rate, the incidence of rotation, the retention rate of the stones, the recurrence rate of the stones, the total incidence of complications, and the postoperative hospitalization time do not have publishing bias. The funnel diagram is shown in Figure 13. The incidence of bile missing and bile tubeitis has been published (P <0.05), and the incidence of the remaining complications has published bias (P> 0.05). Table 2 in the Egger test results.
Table 2 Egger inspection results of each ending indicator
Ending indicator
|
coefficient
|
SE
|
t
|
P
|
CBD Qingshi Rate
|
-2.164
|
2.461
|
-0.88
|
0.398
|
Turnover
|
2.029
|
1.309
|
1.55
|
0.152
|
Stones residue rate
|
-1.043
|
2.025
|
-0.51
|
0.618
|
Lone recurrence rate
|
0.591
|
0.675
|
0.88
|
0.431
|
General incidence of complications
|
-0.636
|
0.568
|
-1.12
|
0.278
|
Bile leak
|
4.890
|
1.416
|
3.45
|
0.005
|
Abdominal infection/incision infection
|
0.493
|
0.942
|
0.52
|
0.619
|
Biliary bleeding
|
-0.093
|
0.261
|
-0.35
|
0.733
|
cholangitis
|
-0.485
|
0.146
|
-3.33
|
0.021
|
Acute pancreatitis
|
-0.835
|
0.876
|
0.95
|
0.359
|
Postoperative hospitalization time
|
0.065
|
1.778
|
0.04
|
0.971
|