腹腔镜胆总管探查取石术后胆管一期缝合与T管引流比较的系统评价  

Primary Suture versus T-tube Drainage after Laparoscopic Common Bile Duct Stone Exploration: A Systematic Review

作　　者：张日新[1] 郑直[1] 何涛[1] 王勇[1] 屈碧辉[1] 郑小林[1] 李凯[1] 郑英键[1] 李明杰[1] 

机构地区：[1]武汉市中心医院肝胆胰腹腔镜外科,武汉430010

出　　处：《中国循证医学杂志》2011年第10期1161-1165,共5页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价腹腔镜下胆总管探查取石后胆管一期缝合(LBEPS)与腹腔镜下胆总管探查取石后T管引流(LCHTD)治疗胆总管结石的效果,为医患双方合理选择术式提供证据。方法计算机检索Cochrane图书馆临床对照试验数据库(2010年第2期)、PubMed(1978～2010)、EMbase(1966～2010)、CBM(1978～2010)、CNKI(1979～2010)和中华医学会数字化期刊系统(1990～2010),并手工检索中、英文已发表的资料和会议论文并追索纳入文献的参考文献,查找比较LBEPS与LCHTD治疗胆总管结石的随机或半随机对照试验。在对纳入研究进行方法学质量评价后,采用RevMan 5.0软件进行Meta分析。结果共纳入3个随机对照试验和1个半随机对照试验,合计274例患者。Meta分析结果表明:与LCHTD相比,LBEPS能缩短手术时间[WMD=–17.11,95%CI(–25.86,–8.36)]、腹腔引流时间[WMD=–0.74,95%CI(–1.39,–0.10)]、术后住院天数[WMD=–3.30,95%CI(–3.67,–2.92)]和减少住院费用[WMD=–2998.75,95%CI(–4396.24,–1601.26)],而且还能降低由放置T管引起的脱管及拔管后胆漏、胆汁性腹膜炎等并发症的发生[RR=0.56,95%CI(0.29,1.09)]。结论 LBEPS治疗胆总管结石总体疗效优于与LCHTD,其前提是需严格掌握手术适应症。由于纳入研究质量普遍较低,上述结论尚需开展更多设计合理、执行严格的多中心大样本且随访时间足够的随机对照试验加以验证。Objective To assess the benefits and harms of routine primary suture（LBEPS） versus T-tube drainage（LCHTD） following laparoscopic common bile duct stone exploration.Methods The randomized controlled trials（RCTs） or quasi-RCTs were electronically searched from the Cochrane Controlled Trials Register（The Cochrane Library,Issue 2,2010）,PubMed（1978 to 2010）,EMbase（1966 to 2010）,CBMdisc（1978 to 2010）,and CNKI（1979 to 2010）;and the relevant published and unpublished data and their references were also searched by hand.The data were extracted and the quality was evaluated by two reviewers independently,and the RevMan 5.0 software was used for data analysis.Results Four studies including 3 RCTs and 1 quasi-RCT involving 274 patients were included.The meta-analysis showed that compared with LCHTD,LBEPS was better in shortening operation time（WMD= –17.11,95%CI –25.86 to –8.36）,abdominal drainage time（WMD= –0.74,95%CI –1.39 to –0.10） and post-operative hospitalization time（WMD= –3.30,95%CI –3.67 to –2.92）,in lowering hospital expenses（WMD= –2 998.75,95%CI –4 396.24 to –1 601.26） and in reducing the complications due to T-tube such as tube detaching,bile leakage after tube drawing,and choleperitonitis（RR=0.56,95%CI 0.29 to 1.09）.Conclusion LBEPS is superior to LCHTD in total effectiveness for common bile duct stone with the precondition of strictly abiding by operation indication.Due to the low quality of the included studies which decreases the reliability of this conclusion,more reasonably-designed and strictly-performed multi-centered RCTs with large scale and longer follow up time are required to further assess and verify the efficacy and safety of this treatment.

关 键 词：腹腔镜胆总管探查 胆总管结石 一期缝合 T管引流 系统评价 Meta分析 

分 类 号：R657.4[医药卫生—外科学]