成人活体肝移植R-Y吻合术与D-D吻合术对术后胆道并发症影响的Meta分析  

A meta-analysis of the biliary complications in adult living donor liver transplantation to compare duct-to-duct hepaticocholedochostomy with Roux-en-Y hepaticojejunostomy biliary reconstruction

作　　者：张崇[1] 张佳林[1] 张成硕[1] 孙宁[1] 李鑫[1] 

机构地区：[1]中国医科大学附属第一医院肝胆外科暨器官移植科,沈阳110001

出　　处：《中华肝胆外科杂志》2015年第3期181-184,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 比较胆管空肠R-Y吻合术（Roux-en-Y hepaticojejunostomy,R-Y HJ）与胆管端端吻合术（duct-to-duct hepaticocholedochostomy,D-D HC）在成人活体肝移植中的并发症发生率.方法 检索Medline-PubMed、EMBASE、Scielo-LILACS数据库相关文献,使用Cochrane Databases进行数据处理,计算其在95％可信区间时的并发症例数.结果 依据纳入标准和排除标准,共筛选出7篇文献,均为有关成人活体肝移植R-Y HJ与D-D HC术后胆道并发症的临床研究.对两种方法总体并发症率、胆道狭窄率和胆汁漏率三项指标进行分析比较,显示总体并发症率和胆道狭窄率,R-Y HJ组均低于D-D HC组的治疗模式.胆漏发生率R-Y HJ组与D-D HC组差异无统计学意义（总体并发症率P＜0.05,OR=0.35,95％ CI0.15～0.81,I2=28％;胆道狭窄率P＜0.05,OR=0.43,95％ CI0.29～0.65,I2=49％.胆汁漏率P=0.05,OR=1.62,95％ CI1.01～2.60,I2=19％）.结论 本Meta分析表明,R-Y吻合术是成人活体肝移植中胆管重建的可行、有效的方法.Objective To compare the incidences of biliary complication after adult living donor liver transplantation （ALDLT） using Roux-en-Y hepaticojejunostomy （R-Y HJ） with duct-to-duct hepaticocholedochostomy （D-D HC）.Methods A meta-analysis was conducted by searching the Medline-PubMed,EMBASE,Scielo-LILACS,and Cochrane Databases.A comparison using 95% confidence intervals was performed on different biliary reconstruction techniques in liver transplantation with regard to occurrence of biliary complications.Results According to our predetermined inclusion and exclusion criteria,seven clinical studies were selected to compare D-D HC with R-Y HJ.The overall biliary comphcation rates,biliary stricture rates and biliary leakage rates were compared.The overall biliary complication rate and the biliary stricture rate of R-Y HJ were significantly less than D-D HC,but the biliary leakage rate of R-Y HJ was similar with the D-D HC （overall biliary complication rate P 〈 0.05,OR =0.35,95% CI：0.15 ～ 0.81,I2 =28% ; biliary stricture rate P 〈 0.05,OR =0.43,95% CI：0.29 ～ 0.65,I2 =49% ; biliary leakage rate P=0.05,OR=1.62,95% CI：1.01 ～2.60,I2 =19%）.Conclusions The meta-analysis showed that biliary reconstruction in ALDLT should be performed using R-Y HJ.

关 键 词：活体肝移植 胆道并发症 R-Y吻合术 D-D吻合术 META分析 

分 类 号：R657.3[医药卫生—外科学]