腹腔镜下胆总管结石胆管探查中C管引流的临床应用价值的Meta分析  

Clinical value of C-tube and T-tube drainage in the laparoscopic bile duct exploration for common bile duct stones:a Meta-analysis

作　　者：王垒[1] 张勤[1] 彭贵主[1] 叶啟发[1] 

机构地区：[1]武汉大学中南医院武汉大学肝胆疾病研究院,430071

出　　处：《中华腔镜外科杂志（电子版）》2017年第1期19-24,共6页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：国家自然科学基金新疆联合基金重点支持项目(U1403222);武汉市科技局项目(20160601010033)

摘　　要：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。Objective To compare the clinical value of C-tube and T-tube drainage in the laparoscopic bile duct exploration for common bile duct stones. Methods A meta-analysis was performed on eligible literature in PubMed, MedLine, Web of Knowledge, and other databases from their establishment to Oct. 31,2016 to screen the clinical controlled trials about C-tube and T-tube drainage in the laparoscopic bile duct exploration for common bile duct stones. The major end points were overall biliary complications, bile leaks, residual stones, and the time of tube- removal, operation and hospital stay. After study selection, data extraction and quality assessment were conducted by two reviewers independently. Meta-analysis were performed by using the RevMan 5.3.0 software. Results Seven articles were included, involving 459cases undergoing C-tube drainage and 411 cases undergoing T-tube drainage. The results of Meta-analyses showed that the incidence of residual stones （ RR = 0. 99 ; 95 % CI = 0. 25-3.87 ; P = 0. 99 ） and bile leak （ RR = 0. 39 ; 95% CI =0. 14-1.15; P =0.09） did not increase in the C-tube drainage group compared to those in T-tube drainage group, but in the C-tube drainage group the incidence of overall biliary complication decreased significantly （RR = 0. 25 ; 95% CI = 0. 13-0. 48 ; P 〈 0. 000 1 ） and the times of tube-removal （ RR = - 6. 28 ; 95 % CI = - 8.77- - 3.79 ; P 〈 0. 000 1 ）, operation （ RR = - 14. 26 ; 95 % CI = - 27.55- - 0. 98 ; P = 0. 04） and hospital stay （ RR = - 7.76 ; 95 % CI = - 11.85- - 3.66 ; P = 0. 000 2 ） were shorter than those in the T-tube drainage group. Conclusion Compared to the T-tube drainage, the C-tube drainage in the laparoscopic bile duct exploration for common bile duct stones has obvious advantages. C-tube drainage could be adopted in almost all of the laparoscopic bile duct exploration for common bile duct stones and is well worthy of being promoted prevailingly.

关 键 词：胆总管结石 腹腔镜下胆管探查 C管引流 T管引流 META分析 

分 类 号：R657.42[医药卫生—外科学]