腹腔镜胆总管切开取石术一期缝合的Meta分析

The meta-analysis of primary closure versus routine T-tube drainage in laparoscopic choledocholithotomy

目的系统评价腹腔镜胆总管切开取石术一期缝合的临床效果,为临床提供参考。方法检索国内外关于腹腔镜胆总管切开取石术一期缝合与留置T管的随机对照研究。按照既定的纳入、排除标准,核定检出符合评价标准的文献,提取所需研究数据,采用RevMan4.2软件进行Meta分析。结果纳入的随机对照研究12篇,共计1204例腹腔镜胆总管切开取石术。Meta分析结果显示,与常规留置T管相比,一期缝合胆总管在手术时间、手术后住院时间、手术近期并发症发生率上差异有显著性(均P<0.01);而在术后远期并发症发生率上差异无显著性(P>0.05)。结论在严格掌握适应证的前提下腹腔镜胆总管切开取石术采用一期缝合是安全可行的,可推广应用。

[Objective] To evaluate randomized controlled trials（RCTs） of clinical research of primary closure versus routine T-tube drainage in laparoscopic choledocholithotomy（LCD） and provide scientific basis by systematic review of clinical research.[Methods] The comparison between primary closure and routine T-tube drainage in laparoscopic choledocholithotomy were identified.All the randomized controlled trials were included for Meta analysis with Rev Man 4.2 software.[Results] Twelve eligible randomized controlled trials showed 1204 LCD.The result of meta-analysis indicated that it had significant difference in the risk of recent complications and operative time and post-operative staying time in hospital between primary closure and T-tube drainage（P 0.01）.Primary closure decreased the chance of recent complications and shortened both the operative time and the post-operative staying time in hospital greatly.But the risk of long-term complications had no significant difference between both of them（P 0.05）.Primary closure won＇t increase the risk of long-term complications.[Conclusions] The meta-analysis indicated that primary closure can be recommended for routine and safe application.It can not only shorten the operative time and the post-operative staying time in hospital greatly,but also decrease the risk of recent complications and avoid the potential complications related to the T-tube drainage.