肝切除术后不放置腹腔引流管的安全性与有效性Meta分析

Safety and effectiveness of nonuse of abdominal drainage after hepatectomy: a Meta analysis

目的评价肝切除术后不放置腹腔引流管的安全性及有效性。方法计算机检索PubMed、Embase、Cochrane Library、Google Scholar、Web of Science、中国生物医学文献数据库、维普网、中国知网及万方数据库2016年6月之前发表的关于肝切除术后不放置腹腔引流管的随机对照试验。由两名研究人员根据纳入与排除标准独立地进行文献筛选、数据提取和方法学质量评价。异质性研究采用固定效应模型Meta分析,同质性研究采用随机效应模型Meta分析。结果最终纳入6篇文献,共665例患者,其中不放置腹腔引流管组331例,放置腹腔引流管组334例。Meta分析结果显示,与放置腹腔引流管组比较,不放置腹腔引流管组死亡、腹腔感染、腹腔积液、胆漏、伤口感染、肺部感染与再次手术的不良事件发生率差异无统计学意义(RR=0.86,0.51,0.66,0.60,0.58,0.85,0.75;P>0.05)。两组术后住院时间比较差异无统计学意义(WMD=0.40,P>0.05)。结论肝切除术后常规放置腹腔引流管可能并无必要。

Objective To evaluate the safety and effectiveness of nonuse of abdominal drainageafter hepatectomy.Methods PubMed,Embase,Cochrane Library,Google Scholar,Web of Science,CBM,VPW,CNKI and Wanfang Database were searched for relevant randomized controlled trials aboutnonuse of abdominal drainage after hepatectomy published before June2016.Literature screening,dataextraction,and methodological quality evaluation were independently conducted by two investigatorsbased on the inclusion and exclusion criteria.Heterogeneity study was performed by Meta analysis of fixedeffect model and homogeneity study was performed by Meta analysis of random effect model.ResultsA total of6papers,665patients were included,including331patients in no abdominal drainage group and334patients in abdominal drainage group.The Meta-analysis results showed that there was no significantdifference between no abdominal drainage group and abdominal drainage group in the mortality,incidence ofabdominal infection,abdominal effusion,bile leakage,wound infection,pulmonary infection and reoperation(RR=0.86,0.51,0.66,0.60,0.58,0.85,0.75;P>0.05).In addition,there was no significant difference betweenboth groups in the length of postoperative hospital stay(WMD=0.40,P>0.05).Conclusion Conventionalabdominal drainage may not be necessary for patients after hepatectomy.