腹腔镜胆囊切除术后放置腹腔引流随机对照试验的Meta分析

Peritoneal drainage after laparoscopic cholecystectomy:a meta-analysis of randomized controlled trials

目的:系统评价腹腔镜胆囊切除术后腹腔内引流的有效性。方法:系统检索PubMed、Embase、WebofScience、Cochrane对照试验中心登记册及Cochrane图书馆(2018年11期)、CBM、CNKI、VIP等数据库。系统评价根据PRISMA指南进行,并采用固定与随机效应模型进行Meta分析。结果:共22项研究涉及3866例患者的RCTs(其中引流组2003例,非引流组1863例)纳入研究。Meta分析结果显示,两组腹腔内液体发生率[RR=1.26,95%CI(0.92,1.72),P=0.16]、术后死亡率[RR=0.44,95%CI(0.04,4.72),P=0.50]差异无统计学意义。术后放置腹腔引流未能降低恶心或/和呕吐的总体发生率[RR=1.16,95%CI(0.95,1.42),P=0.15]、肩部疼痛发生率[RR=0.93,95%CI(0.71,1.23),P=0.62]。引流组具有更高的疼痛评分(通过视觉模拟评分测量)[MD=1.00,95%CI(0.58,1.42),P<0.00001],更长的手术时间[MD=6.07,95%CI(2.07,10.08),P=0.003]、术后住院时间[MD=0.73,95%CI(0.29,1.17),P=0.001]。切口感染与放置腹腔引流无关[RR=1.61,95%CI(0.97,2.69),P=0.07]。结论:腹腔镜胆囊切除术术毕放置引流管并无明显优势,腹腔引流的常规使用似乎具有不利的临床结果,对于这种措施应重新考虑。

Objective:To evaluate the effectiveness of intraperitoneal drainage after laparoscopic cholecystectomy.Methods:The PubMed,Embase,Web of Science,Cochrane Controlled Trials Register and the Cochrane Library ( 2018 issue 11),CBM,CNKI, VIP and other databases were systematically searched.The systematic review was performed according to the PRISMA guidelines and a meta-analysis was performed using a fixed and random effects model.Results:A total of 22 studies involving 3 866 patients with randomized controlled trials ( 2 003 patients in the peritoneal drainage group and 1 863 in the non-drainage group) were included in the study. Meta-analysis showed that the incidence of intra-abdominal fluid [RR= 1.26,95% CI ( 0.92,1.72),P= 0.16]and postoperative mortality [RR= 0.44,95% CI( 0.04,4.72),P= 0.50]was not statistically significantly different.Placement of abdominal drainage after surgery failed to reduce the overall incidence of nausea or /and vomiting [RR= 1.16,95% CI ( 0.95,1.42),P= 0.15]and incidence of shoulder pain [RR= 0.93,95% CI( 0.71,1.23),P = 0.62],the difference was not statistically significant.The peritoneal drainage group had a higher pain score ( measured by visual analogue scale)[MD= 1.00,95% CI( 0.58,1.42),P<0.00001].Postoperative abdominal drainage prolonged the operation time [MD= 6.07,95% CI( 2.07,10.08),P = 0.003] and postoperative hospital stay [MD = 0.73,95% CI ( 0.29,1.17),P= 0.001].Incision infection was not associated with placement of abdominal drainage [RR= 1.61,95% CI( 0.97,2.69), P= 0.07].Conclusions:There is no obvious advantage in the placement of drainage tubes after laparoscopic cholecystectomy.Routineuse of abdominal drainage appears to have adverse clinical outcomes and should be carefully reconsidered.