腹腔镜胆总管探查联合鼻胆管引流与T管引流术治疗胆总管结石临床疗效的Meta分析  

Clinical efficacy of laparoscopic common bile duct exploration combined with endoscopic nasobiliary drainage versus T⁃tube drainage in the treatment of choledocholithiasis:a Meta analysis

作　　者：周雪婷 毛蕾[1] 李戟纰 丁霏霏 马珲敏 王祥[2] Zhou Xueting;Mao Lei;Li Jipi;Ding Feifei;Ma Huimin;Wang Xiang(Second Clinical Medical College,Lanzhou University,Lanzhou 730000,China;Department of Gastroenterology,the Second Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第二临床医学院,730000 [2]兰州大学第二医院消化科,730000

出　　处：《中华消化外科杂志》2020年第8期856-868,共13页Chinese Journal of Digestive Surgery

基　　金：兰州市科技局项目(2017⁃RC⁃49)。

摘　　要：目的:系统评价腹腔镜胆总管探查术(LCBDE)联合鼻胆管引流与T管引流治疗胆总管结石的临床疗效。方法:以胆总管结石病、胆总管结石、T管引流、T管、鼻胆管引流、经内镜鼻胆管引流术、ENBD管、ENBD引流,cholelithiasis,common bile duct stone,jaundice,obstructive,Jaundice,gallstone,T-tube drainage,T-tube,t-tube,biliary tract drainge,drainge tube,endoscopic nasobiliary drainage,nasobiliary drainage,nasobiliary tube,endoscopic drainage tubes,endoscopic drainage tube,endoscopic retrograde biliary drainage为检索词,检索PubMed、Medline、Embase、the Cochrane Library、Web of Science、万方数据库、中国期刊全文数据库、中国生物医学文献数据库。检索时间为1960年1月至2019年5月。纳入比较胆总管结石腹腔镜治疗过程中留置鼻胆管与T管引流的随机对照试验(RCT)及高质量非随机对照试验(NRCT)。LCBDE联合术前、术中行鼻胆管引流术设为鼻胆管引流组,LCBDE联合术后行T管引流术设为T管引流组。结局指标:手术时间、术中出血量、术后住院时间、带管时间、术后胃肠道功能恢复时间、治疗费用、手术失败率、术后胆瘘发生率、术后切口感染发生率、术后结石残留率、术后胰腺炎发生率、术后高淀粉酶血症发生率、术后胆汁性腹膜炎发生率。计数资料采用优势比(OR)及其95%可信区间(95%CI)表示,计量资料采用均数差(MD)及其95%CI表示。采用I2和Q检验分析纳入文献异质性,若I2≤50%或P>0.10时,认为无异质性,采用固定效应模型分析;若I2>50%且P≤0.10时,认为存在异质性,采用随机效应模型分析。分析计量资料时,纳入RCT>4篇,进行亚组分析。纳入RCT≤4篇,同时分析NRCT。分析计数资料时,RCT与NRCT合并分析。纳入研究≥10篇,采用漏斗图检验潜在发表偏倚,纳入研究<10篇则不检验。结果:(1)文献检索结果:最终纳入符合标准的相关研究共26篇,包括9篇RCT,4篇半随机化研究�Objective:To systematically evaluate the clinical efficacy of laparoscopic common bile duct exploration(LCBDE)combined with endoscopic nasobiliary drainage(ENBD)versus T-tube drainage in the treatment of choledocholithiasis.Methods:Databases including PubMed(Medline),Embase,the Cochrane Library,Web of Science,Wanfang,CNKI and CBM were searched for literatures from January 1960 to May 2019 with the key words including“胆总管结石病,胆总管结石;T管引流,T管;鼻胆管引流,经内镜鼻胆管引流术,ENBD管,ENBD引流;cholelithiasis,common bile duct stone,jaundice,obstructive,Jaundice,gallstone;T-tube drainage,T-tube,t-tube,biliary tract drainge,drainge tube;endoscopic nasobiliary drainage,nasobiliary drainage,nasobiliary tube,endoscopic drainage tubes,endoscopic drainage tube,endoscopic retrograde biliary drainage”.The randomized controlled trials(RCTs)and high quality non-randomized controlled trials(NRCTs)on comparing ENBD and T-tube drainage during laparoscopic choledocholithotomy were included.Patients who received LCBDE combined with preoperative or intraoperative ENBD were allocated into ENBD group,and patients who received LCBDE combined with postoperative T-tube drainage were allocated into T-tube drainage group.Reported outcomes:operation time,volume of intraoperative blood loss,duration of postoperative hospital stay,time to drainage tube removal,time to postoperative gastrointestinal function recovery,treatment expenses,rate of surgical failure,incidence of postoperative biliary fistula,incidence of postoperative incisional infection,incidence of postoperative residual stones,incidence of postoperative pancreatitis,incidence of postoperative hyperamylasemia,incidence of postoperative bile peritonitis.Count data were represented as odds ratio(OR)and 95%confidence interval(95%CI).Measurement data were represented as mean difference(MD)and 95%CI.The I2 and Q tests were used to analyze literature heterogeneity.I2≤50%or P>0.10 indicated no significant heterogeneity,so fixed effects model w

关 键 词：胆道良性疾病 胆总管结石 腹腔镜胆总管探查术 T管引流 鼻胆管引流 内镜逆行胰胆管造影 META分析 

分 类 号：R657.42[医药卫生—外科学]