腹腔镜下经胆囊管切开胆总管取石并胆道一期缝合的Meta分析  

A Meta-analysis of laparoscopic common bile duct exploration via cystic duct incision and primary ductal closure

作　　者：何明彦[1] 任维维[1] 周霞东[1] 张发展[1] 郑鹏[1] 

机构地区：[1]甘肃省肿瘤医院腹外三科,甘肃兰州730050

出　　处：《甘肃医药》2016年第7期481-485,共5页Gansu Medical Journal

基　　金：兰州市科技局医疗卫生类项目(项目编号:2013-3-37)

摘　　要：目的:系统评价腹腔镜下经胆囊管切开胆总管取石并胆道一期缝合的临床效果,为临床提供参考。方法:计算机在Pub Med、EMbase、Cochrane Library、中国学术期刊全文数据库、数字化期刊全文数据库、中国科技期刊数据库和中国生物医学文献数据库等电子数据库中检索关于腹腔镜下经胆囊管切开胆总管取石并胆道一期缝合治疗肝外胆管结石的文献资料,查找时限设定为各数据库建库起至2016年2月1日。按照纳入排除标准进行文献筛选和相应质量评价工具进行质量评估后确定纳入文献,然后阅读文献全文对相关研究资料进行提取,最后采用Rev Man5.0统计软件对数据进行Meta分析。结果:本研究共纳入5篇文献,合计809例患者,其中观察组343例,对照组466例,Meta分析结果显示:在手术时间方面,腹腔镜下经胆囊管切开胆总管取石并胆道一期缝合并不长于对照组[MD=-5.77,95%CI(-17.45,5.91),P=0.33];在术后引流量方面,腔镜下经胆囊管切开胆总管取石并胆道一期缝合明显少于对照组[MD=-23.70,95%CI(-34.46,-12.94),P<0.0001];在术后住院时间方面,腔镜下经胆囊管切开胆总管取石并胆道一期缝合明显短于对照组[MD=-3.53,95%CI(-6.42,-0.64),P=0.02];在胆漏发生率方面,腔镜下经胆囊管切开胆总管取石并胆道一期缝合明显低于对照组[OR=0.19,95%CI(0.07,0.56),P=0.003]。结论:虽然腹腔镜下经胆囊管切开胆总管取石并胆道一期缝合治疗肝外胆管结石安全、可行,但有待进一步研究。Objective：To systematically evaluate the efficacy of laparoscopic common bile duct exploration via cystic duct incisionand primary ductal closure and provide scientific basis by systematic review of clinical research.Methods：The clinical trials of laparoscopiccommon bile duct exploration via cystic duct incision and primary ductal closure were electronically searched from the Pub Med,EMbase,Co-chrane library,CNKI,Wan Fang,VIP and CBM Database from inception to February 1,2016.After selecting of the trials according to the inclu-sive and exclusive criteria,the quality of trials was evaluated according to the quality assessment tool.Then data on the characteristics were al-so extracted in reviewing full literature.The Rev Man5.0 software was used for data analysis.Results：Five trials with 809 patients were includ-ed.Meta-analysis revealed that there was no significant difference in the operating time between the test group and the control group[MD=-5.77,95%CI（-17.45,5.91）,P=0.33];The peritoneal drainage[MD=-23.70,95%CI（-34.46,-12.94）,P〈0.0001],postoperative hospitaliza-tion duration[MD=-3.53,95%CI（-6.42,-0.64）,P=0.02]and the incidences of postoperative bile leakage[OR=0.19,95%CI（0.07,0.56）,P=0.003]were decreased in the test group compared with those in the control group.Conclusion：Laparoscopic common bile duct exploration via cys-tic duct incision and primary ductal closure is safer,more minimally invasive and more feasible,but more randomized controlled trials are needed.

关 键 词：腹腔镜 胆囊管切开胆总管取石 一期缝合 META分析 

分 类 号：R195.1[医药卫生—卫生统计学]