无胆道重建肝切除术后胆漏危险因素的Meta分析

刘飞; 李海; 巫强

doi:10.3969/j.issn.1001-5256.2022.03.019

无胆道重建肝切除术后胆漏危险因素的Meta分析

DOI: 10.3969/j.issn.1001-5256.2022.03.019

成都医学院第一附属医院肝胆胰外科，成都 610500

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：刘飞负责论文构思、文献检索、资料提取、撰写论文；李海负责文献的二次检索及修改文章；巫强指导撰写文章并最后定稿。

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通信作者:
巫强, E-mail: wqsc111@163.com

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出版历程
- 收稿日期: 2021-07-16
- 录用日期: 2021-09-23
- 出版日期: 2022-03-20

Risk factors for bile leakage after hepatectomy without biliary reconstruction: A Meta - analysis

Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China

More Information

Corresponding author: WU Qiang, wqsc111@163.com (ORCID: 0000-0001-7774-9720)

摘要

摘要: 目的系统探讨无胆道重建肝切除术后胆漏的危险因素。方法计算机检索中国知网、万方、维普、PubMed、Embase、Web of Science、Cochrane Library等数据库，收集从建库至2021年4月国内外关于无胆道重建肝切除术后胆漏相关危险因素的研究报道，检索语言仅限于中文和英文。按照Cochrane系统评价方法筛选文献、提取资料并运用纽卡斯尔-渥太华量表进行质量评价。应用RevMan 5.4软件对提取的数据进行Meta分析。结果共纳入16篇文献，其中英文13篇，中文3篇，总病例数16 036例。Meta分析结果显示，性别(OR=1.27，95%CI：1.09~1.48，P=0.003)、糖尿病(OR=1.23，95%CI：1.07~1.41，P=0.003)、既往肝脏手术史(OR=2.50，95%CI：1.74~3.59，P < 0.001)、解剖性肝切除(OR=1.58，95%CI：1.09~2.30，P=0.02)、Ⅰ段肝切除(OR=2.56，95%CI：1.50~4.40，P < 0.001)、中央肝切除(S4、S5、S8)(OR=3.51，95%CI：2.80~4.40，P < 0.001)、左三肝切除(OR=3.53，95%CI：2.32~5.36，P < 0.001)、术中输血(OR=2.64，95%CI：1.93~3.60，P < 0.001)为肝切除术后胆漏的危险因素。肝硬化、术前肝功能分级、术前化疗、左/右半肝切除不是胆漏的危险因素(P值均＞0.05)。结论影响肝切除术后胆漏的因素较复杂，除性别、糖尿病、既往肝脏手术史等患者自身因素外，术式、切肝范围、术中输血等术中因素也是肝切除术后发生胆漏的危险因素，术者应进行充分的术前评估，术中谨慎操作，以尽可能降低术后胆漏的发生。
- 肝切除术 /
- 胆漏 /
- 危险因素 /
- Meta分析(主题)
Abstract: Objective To investigate the risk factors for bile leakage after hepatectomy without biliary reconstruction. Methods CNKI, Wanfang Data, VIP, PubMed, Embase, Web of Science, and The Cochrane Library were searched for English and Chinese study reports on the risk factors for bile leakage after hepatectomy without biliary reconstruction published up to April 2021. The method of Cochrane systematic review was used for literature screening and data extraction, and Newcastle-Ottawa Scale was used for quality assessment. RevMan 5.4 software was used to perform a meta-analysis of the extracted data. Results A total of 16 articles (13 in English and 3 in Chinese) were included in this study, with a total of 16036 cases. The meta-analysis showed that sex (odds ratio [OR]=1.27, 95%CI: 1.09-1.48, P=0.003), diabetes (OR=1.23, 95%CI: 1.07-1.41, P=0.003), past history of liver surgery (OR=2.50, 95%CI: 1.74-3.59, P < 0.001), anatomic hepatectomy (OR=1.58, 95%CI: 1.09-2.30, P=0.02), segment I hepatectomy (OR=2.56, 95%CI: 1.50-4.40, P < 0.001), central hepatectomy (S4, S5, S8) (OR=3.51, 95%CI: 2.80-4.40, P < 0.001), left third hepatectomy (OR=3.53, 95%CI: 2.32-5.36, P < 0.001), and intraoperative blood transfusion (OR=2.64, 95%CI: 1.93-3.60, P < 0.001) were the risk factors for bile leakage after hepatectomy. Liver cirrhosis, preoperative liver function grade, preoperative chemotherapy, and left/right hemihepatectomy were not the risk factors for bile leakage. Conclusion There are complex influencing factors for bile leakage after hepatectomy, and in addition to the patient's own factors such as sex, diabetes, and past history of liver surgery, intraoperative factors, such as surgical procedures, extent of hepatectomy, and intraoperative blood transfusion, are also risk factors for bile leakage after hepatectomy. The surgeon should conduct adequate preoperative assessment and perform careful operation during surgery to reduce the incidence rate of postoperative bile leakage.
- Hepatectomy /
- Bile Leakage /
- Risk Factors /
- Meta-Analysis as Topic

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图 1 文献筛选流程图

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图 2 性别对胆漏影响的Meta分析森林图

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图 3 肝硬化对胆漏影响的Meta分析森林图

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图 4 术前肝功能Child-Pugh A/B级对胆漏影响的Meta分析森林图

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图 5 糖尿病对胆漏影响的Meta分析森林图

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图 6 术前化疗对胆漏影响的Meta分析森林图

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图 7 既往有肝脏手术史对胆漏影响的Meta分析森林图

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图 8 解剖性/非解剖性肝切除对胆漏影响的Meta分析森林图

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图 9 右半肝切除对胆漏影响的Meta分析森林图

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图 10 左半肝切除对胆漏影响的Meta分析森林图

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图 11 Ⅰ段肝切除对胆漏影响的Meta分析森林图

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图 12 中央肝切除对胆漏影响的Meta分析森林图

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图 13 左三肝切除对胆漏影响的Meta分析森林图

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图 14 术中输血对胆漏影响的Meta分析森林图

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表 1 纳入研究的基本特征及质量评价

作者	年份	国家	样本量(例)	男/女(例)	年龄(岁)	结果(漏/未漏，例)	质量评价(分)
Yamashita等^[2]	2021	日本	10 102	8039/2063		726/9376	7
Sakamoto等^[8]	2016	日本	334	242/92	32~87	30/304	6
Sadamori等^[9]	2013	日本	359	292/67	32~89	46/313	6
Panaro等^[10]	2016	法国	411	240/171	18~84	42/369	7
Nakano等^[11]	2018	日本	556	445/111		28/528	7
Capussotti等^[12]	2006	意大利	610	369/241	2~86	22/588	5
Donadon等^[13]	2016	意大利	475	326/149	23~85	72/403	6
Erdogan等^[14]	2008	荷兰	234	113/121		16/218	6
Guillaud等^[15]	2013	法国	1001	683/318	16~90	80/921	6
Harimoto等^[16]	2020	日本	270	195/75	28~89	11/259	5
Sadamori等^[17]	2010	日本	293	238/55	32~89	38/255	5
Ishii等^[18]	2011	日本	247	158/89		26/221	5
Kajiwara等^[19]	2016	日本	518	364/154	20~84	81/437	6
吕孟斐等^[20]	2015	中国	201	159/42	1~70	42/159	5
邓仲鸣等^[21]	2016	中国	109	74/35	22~73	23/86	5
翟中山^[22]	2015	中国	316	179/137	20~74	47/269	6

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