腹腔镜胆总管探查一期缝合与胆道内支架引流一期缝合疗效比较的Meta分析

Meta-analysis of efficacy comparison between laparoscopic common bile duct exploration with primary suture and biliary drainage stenting with primary suture

目的:通过Meta分析比较腹腔镜胆总管探查一期缝合(PS)与胆道内支架引流(BDS)+PS的临床疗效,并探讨其临床应用价值。方法:检索国内外数据库中关于腹腔镜胆总管探查(LCBDE)+PS与LCBDE+BDS+PS疗效比较的临床研究。检索时间2010年1月1日至2023年8月1日。观察指标包括手术时间、住院时间、术后胆漏发生率及总并发症发生率,提取相关数据后应用RevMan 5.4软件进行Meta分析。结果:共纳入符合标准的回顾性队列研究5篇,文献累计样本量611例,其中PS组292例、BDS+PS组319例。Meta分析结果显示,两组手术时间(WMD=-1.66,95%CI=-15.78~12.46,P=0.82)、住院时间(WMD=-0.81,95%CI=-2.23~0.60,P=0.26)、残余结石率(OR=1.45,95%CI=0.24~8.83,P=0.69)、总并发症发生率(OR=1.15,95%CI=0.70~1.88,P=0.58)差异无统计学意义,PS组术后胆漏发生率(OR=3.63,95%CI=1.77~7.44,P=0.0004)高于BDS+PS组。结论:对于符合适应证的胆总管结石患者,LCBDE+BDS+PS可一定程度上降低术后胆漏发生率,是安全、有效的。

Objective:Through meta-analysis,this study compared the clinical efficacy of laparoscopic common bile duct exploration(LCBDE)+primary suture(PS)with biliary drainage stenting(BDS)+PS and explored their clinical application value.Methods:The clinical studies comparing the efficacy of LCBDE+PS and LCBDE+BDS+PS in various databases at home and abroad were searched.The search period spanned from Jan.1,2010 to Aug.1,2023.Outcome indicators included operation time,duration of hospita-lization,incidence of postoperative bile leakage and o verall complication rate.Relevant data were extracted and analyzed using RevMan 5.4 software.Results:Five retrospective cohort studies meeting the inclusion criteria were included,covering a sample size of 611 c ases.There were 292 cases in the PS group,and 319 c ases in the BDS+PS group.The results of the meta-analysis indicated no significant differences in operation time(WMD=-1.66,95%CI=-15.78~12.46,P=0.82),duration of hospitalization(WMD=-0.81,95%CI=-2.23~0.60,P=0.26),residual stone rate(OR=1.45,95%CI=0.24~8.83,P=0.69),and overall complication rate(OR=1.15,95%CI=0.70~1.88,P=0.58)between the two groups.However,the incidence of postoperative bile leakage(OR=3.63,95%CI=1.77~7.44,P=0.0004)was higher in the PS group than that in the BDS+PS group.Conclusions:For choledocholithiasis patients who meet the indications,LCBDE+BDS+PS can r educe the i ncidence of postoperative bile leakage to a certain extent,which is safe and effective.