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

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。

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.