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

周泽; 王国泰; 杨兴武

doi:10.3969/j.issn.1001-5256.2018.07.027

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

DOI: 10.3969/j.issn.1001-5256.2018.07.027

1. 陕西中医药大学
2. 陕西中医药大学附属医院肝胆外科

基金项目:

咸阳市科技计划项目(2015K04.10)；

详细信息

中图分类号: R657.4
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出版历程
- 收稿日期: 2018-01-24
- 出版日期: 2018-07-20

Clinical effect of primary suture versus T-tube drainage in laparoscopic choledocholithotomy: A meta-analysis

Shaanxi University of Traditional Chinese Medicine

Research funding:

摘要

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Pub Med、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Rev Man5.3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...
- 胆总管结石 /
- 腹腔镜检查 /
- 一期缝合 /
- Meta分析
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 Pub Med, 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 Rev Man5. 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.
- choledocholithiasis /
- laparoscopy /
- primary suture /
- Meta-analysis

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参考文献(23)

[1]LI J, WEI XG, LU QM, et al.Research advances in association between diseases outside the gallbladder and gallstones[J].J Clin Hepatol, 2016, 32 (5) :1018-1021. (in Chinese) 李娟, 魏小果, 卢启明, 等.胆外疾病与胆囊结石相关性的研究进展[J].临床肝胆病杂志, 2016, 32 (5) :1018-1021.

[2]HALLDESTAM I, ENELL EL, KULLMAN E, et al.Development of symptoms and complications in individuals with asymptomatic gallstones[J].Br J Surg, 2004, 91 (6) :734-738.

[3]TIAN Y, WU SD.Improvement of minimally invasive therapies and techniques for intra-and extrahepatic bile duct stones[J].J Clin Hepatol, 2017, 33 (2) :253-255. (in Chinese) 田雨, 吴硕东.肝内外胆管结石微创治疗方法和技术的改进[J].临床肝胆病杂志, 2017, 33 (2) :253-255.

[4]MOHER D, SC M.The CONSORT Guidelines:Improving the quality of research.Consolidated Standards of Reporting Trials.Interview by Bonnie Horrigan[J].Altern Ther Health Med, 2002, 8 (3) :103-108.

[5]DECKER G, BORIE F, MILLAT B, et al.One hundred laparoscopic choledochotomies with primary closure of the common bile duct[J].Surg Endosc, 2003, 17 (1) :12-18.

[6]WILLS VL, GIBSON K, KARIHALOOT C, et al.Complications of biliary T-tubes after choledochotomy[J].ANZ J Surg, 2002, 72 (3) :177-180.

[7]PAN Z, CHENG ZJ, LIU SL, et al.Primary closure versus T-tube drainage following laparoscopic common bile duct exploration for choledocholithiasis[J].Chin J Gen Surg, 2015, 24 (8) :1135-1139. (in Chinese) 潘峥, 程张军, 刘胜利, 等.胆总管结石腹腔镜胆总管探查术后一期缝合与T管引流的临床比较[J].中国普通外科杂志, 2015, 24 (8) :1135-1139.

[8]WANG GY, LI KW, LI F, et al.Primary closure versus T-tube drainage after laparoscopic common bile duct exploration[J].Chin J Gen Surg, 2013, 22 (2) :140-144. (in Chinese) 王贵阳, 李可为, 李甫, 等.腹腔镜胆总管探查术后一期缝合与T管留置的疗效比较[J].中国普通外科杂志, 2013, 22 (2) :140-144.

[9]ZHENG GW, ZHANG H, FENG QS.Clinical analysis of primary duct closure after laparoscopic common bile duct exploration[J].China J Endosc, 2011, 17 (8) :798-801. (in Chinese) 郑光威, 张寰, 冯秋实.腹腔镜胆总管探查术后胆管一期缝合的临床应用分析[J].中国内镜杂志, 2011, 17 (8) :798-801.

[10]WENG CH, HONG DF.A comparative study of primary suture versus T-tube drainage in laparoscopic common bile duct exploration[J].Chin J Min Inv Surg, 2007, 7 (9) :861-862. (in Chinese) 翁辞海, 洪德飞.腹腔镜胆总管探查一期缝合与置T管引流的对比研究[J].中国微创外科杂志, 2007, 7 (9) :861-862.

[11]LIAO NS, LIN F, XIN DY.Clinical application of endoscopic nasobiliary drainage in laparoscopic common bile duct exploration and primary suture[J].China J Endosc, 2016, 22 (1) :28-31. (in Chinese) 廖南生, 林峰, 辛栋轶.鼻胆管引流在腹腔镜胆总管切开一期缝合中的临床应用[J].中国内镜杂志, 2016, 22 (1) :28-31.

[12]LU BC, REN PT, SHEN ZH, et al.A study on preiperative placement of ENBD tube in the application of laparoscopic common bile duct exploration with primary suture[J].China J Endosc, 2010, 16 (10) :1034-1037. (in Chinese) 鲁葆春, 任培土, 沈志宏, 等.术前鼻胆管引流在腹腔镜胆总管探查一期缝合中的应用[J].中国内镜杂志, 2010, 16 (10) :1034-1037.

[13]SHAO LJ, LU CD, WU JJ, et al.Application of self-releasing singel-J tube instead of T-tube drainage in the application of the patients with common bile duct stones laparotomy[J].J Hepatobiliary Surg, 2016, 24 (1) :36-38. (in Chinese) 邵立军, 卢潮德, 吴建军, 等.自行脱落单J管替代T管引流在胆总管结石开腹手术患者中的应用[J].肝胆外科杂志, 2016, 24 (1) :36-38.

[14]ZHONG YS, LIU B, DENG MH, et al.Effect of laparoscopic C tube drainage combining with primary suture of common bile duct on patients with extrahepatic cholangiolithiasis[J/CD].Chin J Hepatic Surg:Electronic Edition, 2013, 2 (4) :10-13. (in Chinese) 钟跃思, 刘波, 邓美海, 等.腹腔镜下C管胆道引流及胆总管一期缝合治疗肝外胆管结石患者的疗效分析[J/CD].中华肝脏外科手术学电子杂志, 2013, 2 (4) :10-13.

[15]CHEN XM, ZHANG Y, CAI HH, et al.Transcystic approach with micro-incision of the cystic duct and its confluence part in laparoscopic common bile duct exploration[J].J Laparoendosc Adv Surg Tech A, 2013, 23 (12) :977-981.

[16]LEIDA Z, PING B, SHUGUANG W, et al.A randomized comparison of primary closure and T-tube drainage of the common bile duct after laparoscopic choledochotomy[J].Surg Endosc, 2008, 22 (7) :1595-1600.

[17]EL-GEIDIE AA.Is the use of T-tube necessary after laparoscopic choledochotomy?[J].J Gastrointest Surg, 2010, 14 (5) :844-848.

[18]DONG ZT, WU GZ, LUO KL, et al.Primary closure after laparoscopic common bile duct exploration versus T-tube[J].J Surg Res, 2014, 189 (2) :249-254.

[19] CHEN AP, ZENG QT, ZHOU HB, et al.Clinical efficacy of primary closure in laparoscopic common bile duct exploration (A report of 2429cases) [J].Chin J Dig Surg, 2018, 17 (3) :299-303. (in Chinese) 陈安平, 曾乾桃, 周华波, 等.腹腔镜胆总管探查一期缝合术的临床疗效 (附2429例报告) [J].中华消化外科杂志, 2018, 17 (3) :299-303.

[20] YANG Y, ZHANG J, LOU JY, et al.Clinical efficacies of free endoscopic nasobiliary drainage in primary duct closure following laparoscopic common bile duct exploration:A multicenter retrospective study (A report of 312 cases) [J].Chin J Dig Surg, 2018, 17 (1) :68-75. (in Chinese) 杨彦, 张剑, 楼健颖, 等.腹腔镜胆总管探查取石免留置鼻胆管引流一期缝合术临床疗效的多中心回顾性研究 (附312例报告) [J].中华消化外科杂志, 2018, 17 (1) :68-75.

[21]LANGE V, RAU HG, SCHARDEY HM, et al.Laparoscopic stenting for protection of common bile duct sutures[J].Surg Laparosc Endosc, 1993, 3 (6) :466-469.

[22]CHEN XG, GONG LT, YOU DP.Clinical effect of primary suture in laparoscopic common bile duct exploration:an analysis of 39 cases[J].J Hepatopancreatobiliary Surg, 2006, 18 (3) :178-179. (in Chinese) 陈晓岗, 龚利挺, 尢大朴.腹腔镜胆总管探查一期缝合术39例分析[J].肝胆胰外科杂志, 2006, 18 (3) :178-179.

[23]KITANO S, BANDOH T, YOSHIDA T, et al.Transcystic C-tube drainage following laparoscopic common bile duct exploration[J].Surg Technol Int, 1994, 3:181-186.

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