无胆道重建肝切除术后胆漏危险因素的Meta分析  

Risk factors for bile leakage after hepatectomy without biliary reconstruction:A Meta-analysis

作　　者：刘飞 李海 巫强[1] LIU Fei;LI Hai;WU Qiang(Department of Hepatobiliary Surgery,The First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China)

机构地区：[1]成都医学院第一附属医院肝胆胰外科,成都610500

出　　处：《临床肝胆病杂志》2022年第3期594-600,共7页Journal of Clinical Hepatology

摘　　要：目的系统探讨无胆道重建肝切除术后胆漏的危险因素。方法计算机检索中国知网、万方、维普、PubMed、Embase、Web of Science、Cochrane Library等数据库,收集从建库至2021年4月国内外关于无胆道重建肝切除术后胆漏相关危险因素的研究报道,检索语言仅限于中文和英文。按照Cochrane系统评价方法筛选文献、提取资料并运用纽卡斯尔-渥太华量表进行质量评价。应用RevMan 5.4软件对提取的数据进行Meta分析。结果共纳入16篇文献,其中英文13篇,中文3篇,总病例数16036例。Meta分析结果显示,性别(OR=1.27,95%CI:1.09~1.48,P=0.003)、糖尿病(OR=1.23,95%CI:1.07~1.41,P=0.003)、既往肝脏手术史(OR=2.50,95%CI:1.74~3.59,P<0.001)、解剖性肝切除(OR=1.58,95%CI:1.09~2.30,P=0.02)、Ⅰ段肝切除(OR=2.56,95%CI:1.50~4.40,P<0.001)、中央肝切除(S4、S5、S8)(OR=3.51,95%CI:2.80~4.40,P<0.001)、左三肝切除(OR=3.53,95%CI:2.32~5.36,P<0.001)、术中输血(OR=2.64,95%CI:1.93~3.60,P<0.001)为肝切除术后胆漏的危险因素。肝硬化、术前肝功能分级、术前化疗、左/右半肝切除不是胆漏的危险因素(P值均>0.05)。结论影响肝切除术后胆漏的因素较复杂,除性别、糖尿病、既往肝脏手术史等患者自身因素外,术式、切肝范围、术中输血等术中因素也是肝切除术后发生胆漏的危险因素,术者应进行充分的术前评估,术中谨慎操作,以尽可能降低术后胆漏的发生。Objective To investigate the risk factors for bile leakage after hepatectomy without biliary reconstruction.Methods CNKI,Wanfang Data,VIP,PubMed,Embase,Web of Science,and The Cochrane Library were searched for English and Chinese study reports on the risk factors for bile leakage after hepatectomy without biliary reconstruction published up to April 2021.The method of Cochrane systematic review was used for literature screening and data extraction,and Newcastle-Ottawa Scale was used for quality assessment.RevMan 5.4 software was used to perform a meta-analysis of the extracted data.Results A total of 16 articles(13 in English and 3 in Chinese)were included in this study,with a total of 16036 cases.The meta-analysis showed that sex(odds ratio[OR]=1.27,95%CI:1.09-1.48,P=0.003),diabetes(OR=1.23,95%CI:1.07-1.41,P=0.003),past history of liver surgery(OR=2.50,95%CI:1.74-3.59,P<0.001),anatomic hepatectomy(OR=1.58,95%CI:1.09-2.30,P=0.02),segment I hepatectomy(OR=2.56,95%CI:1.50-4.40,P<0.001),central hepatectomy(S4,S5,S8)(OR=3.51,95%CI:2.80-4.40,P<0.001),left third hepatectomy(OR=3.53,95%CI:2.32-5.36,P<0.001),and intraoperative blood transfusion(OR=2.64,95%CI:1.93-3.60,P<0.001)were the risk factors for bile leakage after hepatectomy.Liver cirrhosis,preoperative liver function grade,preoperative chemotherapy,and left/right hemihepatectomy were not the risk factors for bile leakage.Conclusion There are complex influencing factors for bile leakage after hepatectomy,and in addition to the patient’s own factors such as sex,diabetes,and past history of liver surgery,intraoperative factors,such as surgical procedures,extent of hepatectomy,and intraoperative blood transfusion,are also risk factors for bile leakage after hepatectomy.The surgeon should conduct adequate preoperative assessment and perform careful operation during surgery to reduce the incidence rate of postoperative bile leakage.

关 键 词：肝切除术 胆漏 危险因素 Meta分析(主题) 

分 类 号：R73[医药卫生—肿瘤]