腹腔镜胆总管一期缝合与 T管引流术安全性的荟萃分析

Primary duct cclousure versus T-tube drainage after laprascopic common bile duct exploration(LCBDE):a meta-analysis

目的通过与腹腔镜T管引流术(TTD)对比,系统客观的评价腹腔镜胆总管一期缝合术(PDC)的安全性和可行性。方法收集2001年至2021年公开发表的腹腔镜下胆总管进行一期缝合术(PDC)和T管引流术(ITD)的中文和英文文献,对PDC和TTD两组中的术中情况、术后并发症情况及术后恢复情况进行荟萃分析。结果筛选出符合纳入标准的研究7项,共644例,腹腔镜胆总管一期缝合组327例,腹腔镜胆总管T管引流组317例。在手术时间、出血量、并发症发生率、术后住院时间、住院费用方面,PDC组明显少于TTD组,差异有统计学意义(P<0.05);而在中转率、胆漏、术后急性胰腺炎、结石残留率及术后肠道功能恢复时间方面,差异无统计学意义(P>0.05)。结论腹腔镜胆总管一期缝合是安全可行的,具有出血少、恢复快及手术并发症发生率低等优点,临床上值得推广。

Objective To study feasibility,security of primary duct clousure(PDC)after LCBDE.Methods Retrieved clinical trials comparing primary duct clousure(PDC)with T-tube drainage(TTD)for choledocholithiasis disease publishen from 2001 to 2021.A meta-analysis was conducted to evaluate operative time,blood loss,conversion rate,bile leakage,postoperative acute pacre-atitis,retained stones,postoperative hospital stay and postoperative complications between PDC group and TTD group.A fixed effect model or random effect model was established to collect the data.Results Seven RCTs on 644 patients qualified for the meta-analysis,327 being allocated to PDC and 317 to TTD.There was no significant difference between PDC and TTD for conversion rate,bile leakage,postoperative acute pacreatitis,retained stones,postoperative intestinal function recovery time.However,operative time was significantly shorter in PDC than TTD(P<0.05),intraoperative bleeding was significantly less in PDC than TTD(P<0.05),the incidence of complications was significantly lower in PDC than TTD(P<0.05),postoperative hospitalization time was significantly shorter in PDC than TTD(P<0.05),hospital expenses were was significantly less in PDC than TTD(P<0.05).Conclusions PDC after LCBDE is safe and feasible,with less bleeding in operation,postoperative recovery and complication,so it is worth promoting in clinic.