胆肠吻合术中应用消化系吻合器吻合与手工缝合比较的Meta分析  

Stapler anastomosis vs manual suture in choledochjejunostomy:A systematic review

作　　者：苏松[1] 李波[1] 贺凯[1] 冯春红[1] 张孟瑜[1] 夏先明[1] 

机构地区：[1]四川省泸州医学院附属医院肝胆外科,四川省泸州市646000

出　　处：《世界华人消化杂志》2015年第17期2810-2815,共6页World Chinese Journal of Digestology

摘　　要：目的:系统评价胆肠吻合术中应用消化系吻合器吻合(stapled anastomosis,SA)与手工缝合(manual suture,MS)的差异性,为临床医师合理选择术式提供循证医学依据.方法:计算机检索Cochrane library,PubMed、EMbase、CENTRAL以及CNKI、中华医学会数字化期刊系统、万方数据库、维普数据库,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SA与MS进行胆肠吻合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软件进行分析.结果:研究最后纳入中文文献5篇,共包括422例患者,其中SA组208例,MS组214例.结果表明:与MS相比,SA能缩短手术时间(WMD=35.42,95%CI:17.82-53.02,P<0.00001),减少术后胆漏的发生率(WMD=4.52,95%CI:1.68-12.24,P=0.003)、减少术后胆道狭窄的形成(WMD=11.06,95%CI:2.49-49.19,P=0.002),缩短术后住院时间(WMD=3.85,95%CI:1.47-6.24,P=0.002).结论:SA进行胆管-空肠吻合效果优于与MS,但需要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为准确。严格的多中心大样本随机对照试验加以验证.AIM：To assess the difference of stapler anastomosis（SA） vs manual suture（MS） in choledochjejunostomy.METHODS：Randomized controlled trials（RCTs） or quasi-RCTs were electronically searched from the Cochrane Library,PubMed,EMbase,CENTRAL,and CNKI,Wanfang database,and Cqvip.The relevant published and unpublished data and their references were also searched manually.The data were extracted and the quality was evaluated by two reviewers independently.RevMan 5.2 software was used for data analysis.RESULTS：Five studies involving 422 patients were included.The meta-analysis showed that compared with MS,SA was better in shortening operative time（WMD = 35.42,95%CI：17.82-53.02,P〈0.00001）,reducing the occurrence of bile leakage（WMD = 4.52,95%CI：1.68-12.24,P-0.003） and stricture of anastomotic stoma（WMD = 11.06,95%CI：2.49-49.19,P = 0.002） and decreasing postoperative hospitalization time（WMD = 3.85,95%CI：1.47-6.24,P = 0.002）.CONCLUSION：SA seems to be superior to MS in choledochjejunostomy.However,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 larger scale are required to further assess and verify the efficacy and safety of this treatment.

关 键 词：胆管空肠吻合术 吻合器吻合 手工缝合 系统评价 META分析 

分 类 号：R657.4[医药卫生—外科学]