防反流瓣对胆道闭锁患儿Kasai手术预后影响的Meta分析  

Effect of creating antireflux valve on the prognosis of Kasai procedure for infantile biliary atresia: a Meta-analysis

作　　者：李明明 潘永康[1] 李中文[1] 王磊[1] 卢朝祥 Li Mingming;Pan Yongkang;Li Zhongwen;Wang Lei;Lu Chaoziang(Department of Neonatal Surgery,Xi'an Children's Hospital,Xi'an 710003,China)

机构地区：[1]西安市儿童医院新生儿外科,西安710003

出　　处：《中华小儿外科杂志》2023年第4期319-324,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的:探讨胆道闭锁Kasai术中行防反流瓣对预后的影响,以指导后期手术操作。方法:检索2021年7月前在PubMed、EMBASE、Cochrane Library、Web of Science、中国知网、万方、维普国内外数据库等收录的关于胆道闭锁Kasai术中行防反流瓣对预后影响的随机或非随机对照研究,手动输入检索词并通过自由组合进行检索,中文检索词包括:"防反流瓣""矩形瓣""肠套叠瓣""胆道闭锁""葛西手术""胆管炎",英文检索词包括:"antireflux valve""rectangle valve""Intussusception valve""biliary atresia""Kasai""cholangitis""survival rate"。应用RevMan5.3软件分析对比胆道闭锁患儿Kasai术中行和未行防反流瓣者术后胆管炎发生率、黄疸清除率及2年自体肝生存率的差异。Stata12.0软件行Begg's检验分析发表偏倚。结果:最终纳入6篇文献,共2984例患儿,其中矩形瓣1篇(60例),肠套叠瓣5篇(2924例)。所有胆道闭锁患儿均行Kasai手术,按手术方式分为行防反流瓣组(670例)和未行防反流瓣组(2314例)。Meta分析结果显示两组在术后胆管炎发生率上差异有统计学意义(OR=0.71,95%CI为0.59~0.86,P<0.01);两组术后黄疸清除率比较差异无统计学意义(OR=1.02,95%CI为0.85~1.22,P=0.85),两组2年自体肝生存率比较差异无统计学意义(OR=1.12,95%CI为0.50~2.51,P=0.77)。Begg's检验显示无明显发表偏倚(P=0.028~0.310)。结论:胆道闭锁患儿Kasai术中行防反流瓣对术后黄疸清除率及2年自体肝生存率无影响,但可有效降低术后胆管炎发生率,建议Kasai手术中行防反流瓣。Objective To explore the effect of antireflux valve on the prognosis of infants with biliary atresia(BA)during Kasai procedure to guide later surgical procedure.Methods Randomized and non-randomized controlled studies were retrieved from the databases of PubMed,EMBASE,Cochrane Library,Web of Science,VIP,WanFang and CNKI until July 2021.Revman5.3 software was utilized for comparing the incidence of postoperative cholangitis,jaundice clearance rate and 2-year survival rate of autologous liver in BA infants during Kasai procedure with and without antireflux valve.Stata12.0 Begg's test was employed for examining the publication bias.Results A total of 6 literatures were retrieved,including 1 rectangular valve(n=60)and 5 intussusception valves(n=2924).Among 2984 BA infants,antireflux valve was applied(n=670)and non-applied(n=2314).Meta-analysis indicated that inter-group statistical difference existed in the incidence of postoperative cholangitis(OR=0.71,95%CI:0.59-0.86,P<0.01);no inter-group statistical difference existed in postoperative jaundice clearance rate(OR=1.02,95%CI:0.85-1.22,P=0.85)or 2-year autogenous liver survival rate(OR=1.12,95%CI:0.50-2.51,P=0.77).And Begg's test revealed no significant publication bias(P=0.028-0.310).Conclusions During Kasai procedure for BA,antireflux valve has no effect on postoperative jaundice clearance rate or 2-year survival rate of autologous liver.However,it may effectively lower the incidence of postoperative cholangitis.Thus antireflux valve is recommended during Kasai procedure.

关 键 词：胆道闭锁 肝门肠吻合术 预后 META分析 

分 类 号：R726.5[医药卫生—儿科]