目的比较评价腹腔镜下胆总管结石胆管探查中C管引流和T管引流的临床价值。方法计算机检索Pubmed、EMbase、sino Med、Web of Science、the Cochrane Central Register of Controlled Trials(CENTRAL)、万方数据库、中国知网及维普数据库...目的比较评价腹腔镜下胆总管结石胆管探查中C管引流和T管引流的临床价值。方法计算机检索Pubmed、EMbase、sino Med、Web of Science、the Cochrane Central Register of Controlled Trials(CENTRAL)、万方数据库、中国知网及维普数据库等,查找并筛选出所有腹腔镜下胆总管结石胆管探查术中比较经C管引流与T管引流临床对照研究,检索时间均为建库至2016年10月31日。结局指标主要有总的胆道并发症发生率、胆漏发生率、胆道残余结石发生率、拔管时间、手术时间、住院时间。按纳入、排除标准,由2位评价者独立进行筛选、资料提取和质量评价后,采用Rev Man(5.30版)软件进行Meta分析。结果共纳入文献7篇,其中C管引流组459例,T管引流组411例。Meta分析结果显示:与T管引流相比,C管引流不会增加胆道残余结石的发生率(RR=0.99;95%CI=0.25~3.87;P=0.99)和胆漏发生的风险(RR=0.39;95%CI=0.14~1.15;P=0.09),但是能显著降低胆道并发症总的发生率(RR=0.25;95%CI=0.13~0.48;P<0.000 1)及缩短术后拔管时间(RR=-6.28;95%CI=-8.77^-3.79;P<0.000 1)和手术时间(RR=-14.26;95%CI=-27.55^-0.98;P=0.04)及住院时间(RR=-7.76;95%CI=-11.85^-3.66;P=0.000 2)。结论腹腔镜下胆总管结石胆管探查胆道引流术中C管引流较T管引流具有明显的优势,并且适用于几乎所有的腹腔镜下肝外胆管结石胆管探查术中,值得临床推广。展开更多
Background:Conservative therapy for Crohn’s disease(CD)-related acute bowel obstruction is essential to avoid emergent surgery.The present study aimed to evaluate the efficacy of using a long intestinal decompression...Background:Conservative therapy for Crohn’s disease(CD)-related acute bowel obstruction is essential to avoid emergent surgery.The present study aimed to evaluate the efficacy of using a long intestinal decompression tube(LT)in treatment of CD with acute intestinal obstruction.Methods:This is a prospective observational study.Comparative analysis was performed in CD patients treated with LT(the LT group)and nasogastric tube(the GT group).The primary outcome was the avoidance of emergent surgery.Additionally,predictive factors for failure of decompression and subsequent surgery were investigated.Results:There were 27 and 42 CD patients treated with LT and GT,respectively,in emergent situations.Twelve(44.4%)patients using LT were managed conservatively without laparotomy,while only nine(21.4%)patients in the GT group were spared from emergent surgery(P<0.05).Both in surgery-free and in surgery patients,the time to alleviation of symptoms was significantly shorter in the LT groups than in the GT groups(both P<0.01).C-reactive protein decrease after intubation and 48-hour drainage volume>500mL were predictors of unavoidable surgery(both P<0.05).The rate of temporary stoma and incidence of incision infection in the LT surgery group were significantly lower than those in the GT group(both P<0.05).No significant differences were observed in the frequency of medical and surgical recurrences between the LT and GT groups(all P>0.05).Conclusions:Endoscopic placement of LT could improve the emergent status in CD patients with acute bowel obstruction.The drainage output and changes in C-reactive protein after intubation could serve as practical predictive indices for subsequent surgery.Compared to traditional GT decompression,LT decompression was associated with fewer short-term complications and did not appear to affect long-term recurrence.展开更多
文摘目的比较评价腹腔镜下胆总管结石胆管探查中C管引流和T管引流的临床价值。方法计算机检索Pubmed、EMbase、sino Med、Web of Science、the Cochrane Central Register of Controlled Trials(CENTRAL)、万方数据库、中国知网及维普数据库等,查找并筛选出所有腹腔镜下胆总管结石胆管探查术中比较经C管引流与T管引流临床对照研究,检索时间均为建库至2016年10月31日。结局指标主要有总的胆道并发症发生率、胆漏发生率、胆道残余结石发生率、拔管时间、手术时间、住院时间。按纳入、排除标准,由2位评价者独立进行筛选、资料提取和质量评价后,采用Rev Man(5.30版)软件进行Meta分析。结果共纳入文献7篇,其中C管引流组459例,T管引流组411例。Meta分析结果显示:与T管引流相比,C管引流不会增加胆道残余结石的发生率(RR=0.99;95%CI=0.25~3.87;P=0.99)和胆漏发生的风险(RR=0.39;95%CI=0.14~1.15;P=0.09),但是能显著降低胆道并发症总的发生率(RR=0.25;95%CI=0.13~0.48;P<0.000 1)及缩短术后拔管时间(RR=-6.28;95%CI=-8.77^-3.79;P<0.000 1)和手术时间(RR=-14.26;95%CI=-27.55^-0.98;P=0.04)及住院时间(RR=-7.76;95%CI=-11.85^-3.66;P=0.000 2)。结论腹腔镜下胆总管结石胆管探查胆道引流术中C管引流较T管引流具有明显的优势,并且适用于几乎所有的腹腔镜下肝外胆管结石胆管探查术中,值得临床推广。
基金This study was supported by the National Natural Science Foundation of China(81770556).
文摘Background:Conservative therapy for Crohn’s disease(CD)-related acute bowel obstruction is essential to avoid emergent surgery.The present study aimed to evaluate the efficacy of using a long intestinal decompression tube(LT)in treatment of CD with acute intestinal obstruction.Methods:This is a prospective observational study.Comparative analysis was performed in CD patients treated with LT(the LT group)and nasogastric tube(the GT group).The primary outcome was the avoidance of emergent surgery.Additionally,predictive factors for failure of decompression and subsequent surgery were investigated.Results:There were 27 and 42 CD patients treated with LT and GT,respectively,in emergent situations.Twelve(44.4%)patients using LT were managed conservatively without laparotomy,while only nine(21.4%)patients in the GT group were spared from emergent surgery(P<0.05).Both in surgery-free and in surgery patients,the time to alleviation of symptoms was significantly shorter in the LT groups than in the GT groups(both P<0.01).C-reactive protein decrease after intubation and 48-hour drainage volume>500mL were predictors of unavoidable surgery(both P<0.05).The rate of temporary stoma and incidence of incision infection in the LT surgery group were significantly lower than those in the GT group(both P<0.05).No significant differences were observed in the frequency of medical and surgical recurrences between the LT and GT groups(all P>0.05).Conclusions:Endoscopic placement of LT could improve the emergent status in CD patients with acute bowel obstruction.The drainage output and changes in C-reactive protein after intubation could serve as practical predictive indices for subsequent surgery.Compared to traditional GT decompression,LT decompression was associated with fewer short-term complications and did not appear to affect long-term recurrence.
