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腹腔镜胆总管切开取石一期缝合与T管引流疗效比较的Meta分析
Clinical effect of primary suture versus T-tube drainage in laparoscopic choledocholithotomy: A meta-analysis
文章发布日期:2018年06月07日  来源:  作者:周泽,王国泰,杨兴武  点击次数:397次  下载次数:99次
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【摘要】:目的 评价腹腔镜下胆总管探查术一期缝合与T管引流的有效性、适应性及优劣点,为临床治疗提供可靠的证据。方法 检索PubMed、OVID、WOS、EMBASE、中国期刊全文数据库、中国万方数据库、中国维普咨询等数据库,文献检索起止时间为2005年1月1日至2016年12月31日。按照纳入及排除标准筛选研究文献,采用RevMan5.3软件进行Meta分析。结果 纳入12篇文献,共收集1222例患者,其中观察组(采用一期缝合)616例,对照组(采用T管引流)606例。腹腔镜下胆总管切开取石一期缝合与T管引流相比,手术时间[加权均数差(WMD)=-10.79,95%可信区间(95%CI):-13.55~-8.03,P<0.001]、术后住院时间(WMD=-4.16,95%CI:-4.84~-3.48,P<0.001)、肛门排气时间(WMD=-8.39,95%CI:-12.50~-4.27,P<0.001)、胆汁引流时间(WMD=-27.06,95%CI:-51.08~-3.04,P=0.03)、胆漏发生率(比值比=0.47,95%CI:0.27~0.82,P=0.008)差异均有统计学意义。结论 腹腔镜下胆总管切开取石一期缝合安全有效,较T管引流具有明显优势,值得在临床推广。
【Abstract】:Objective To investigate the clinical effect, adaptability, and advantages/disadvantages of primary suture versus T-tube drainage in laparoscopic common bile duct exploration (LCBDE), and to provide reliable evidence for clinical treatment. Methods PubMed, OVID, WOS, EMBASE, Chinese Scientific Journal Full-Text Database, Wanfang Data, and VIP were searched for articles published from January 1, 2005 to December 31, 2016. The articles were screened according to inclusion and exclusion criteria, and RevMan 53 software was used for meta-analysis. Results A total of 12 articles were included, with 1222 patients in total, among whom 616 were given primary suture (observation group) and 606 were given T-tube drainage (control group). There were significant differences between primary suture and T-tube drainage in time of operation (weighted mean difference [WMD] =-10.79, 95% confidence interval [CI]: -13.55 to -8.03, P<0.001), length of postoperative hospital stay (WMD=-4.16, 95% CI: -4.84 to -3.48, P<0.001), time to first flatus (WMD=-8.39, 95% CI: -12.50 to -4.27, P<0.001), biliary drainage time (WMD=-27.06, 95% CI: -51.08 to -3.04, P=0.03), and incidence rate of bile leakage (odds ratio = 0.47, 95% CI: 0.27-0.82, P=0.008). Conclusion Primary suture in LCBDE is safe and effective and has significant advantages over T-tube drainage. Therefore, it holds promise for clinical application.
【关键字】:胆总管结石;腹腔镜检查;一期缝合;Meta分析
【Key words】:choledocholithiasis; laparoscopy; primary suture; Meta-analysis
【引证本文】:ZHOU Z, WANG GT, YANG XW. Clinical effect of primary suture versus T-tube drainage in laparoscopic choledocholithotomy: A meta-analysis[J]. J Clin Hepatol, 2018, 34(7): 1502-1507. (in Chinese)
周泽, 王国泰, 杨兴武. 腹腔镜胆总管切开取石一期缝合与T管引流疗效比较的Meta分析[J]. 临床肝胆病杂志, 2018, 34(7): 1502-1507.

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