胆汁回输在梗阻性黄疸患者临床治疗中价值的荟萃分析  

A Meta-analysis of Value of Bile Reinfusion in Clinical Treatment of Patients with Obstructive Jaundice

作　　者：刘缤妍 李慧敏 郝梦迪 刘晓丽 袁大晋 李文杰 黄汶彬 丁磊 LIU Binyan;LI Huimin;HAO Mengdi;LIU Xiaoli;YUAN Dajin;LI Wenjie;HUANG Wenbin;DING Lei(Department of Gastrointestinal Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院胃肠肿瘤外科,北京100038

出　　处：《医学综述》2025年第7期881-892,共12页Medical Recapitulate

摘　　要：目的系统评价胆汁回输在梗阻性黄疸患者临床治疗中的价值。方法全面检索PubMed、万方和中国知网数据库中梗阻性黄疸引流减黄后行胆汁回输的文献,检索时间为建库至2024年9月7日。由两名研究员独立筛选文献、提取资料并评价纳入文献的质量,采用RevMan 5.3软件和Stata 15.0软件进行荟萃分析。结果本研究共纳入11篇文献,荟萃分析结果显示,胆汁回输后1~3 d,两组患者丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)、血清白蛋白(ALB)、前白蛋白(PA)水平比较差异无统计学意义(P>0.05);胆汁回输后5 d至1个月,回输组患者ALT、AST水平明显低于对照组(SMD=-0.35,95%CI-0.51~-0.20,P<0.00001;SMD=-0.23,95%CI-0.40~-0.06,P=0.007),两组患者TBil水平比较差异无统计学意义(P>0.05),回输组患者ALB、PA水平明显高于对照组(SMD=0.86,95%CI 0.43~1.30,P<0.00001;SMD=0.48,95%CI 0.12~0.84,P=0.009);术后5~7 d,回输组患者ALT、AST水平明显低于对照组(SMD=-0.70,95%CI-1.23~-0.17,P=0.01;SMD=-0.54,95%CI-1.03~-0.05,P=0.03),两组患者TBil、ALB、PA水平比较差异无统计学意义(P>0.05);术后10 d,回输组患者ALT、AST、TBil水平明显低于对照组(SMD=-0.38,95%CI-0.59~-0.18,P=0.0003;SMD=-0.22,95%CI-0.42~-0.01,P=0.04;SMD=-0.58,95%CI-0.82~-0.34,P<0.00001),两组患者PA水平比较差异无统计学意义(P>0.05)。回输组患者术后排气时间、总住院时间短于对照组(SMD=-0.54,95%CI-0.83~-0.26,P=0.0002;SMD=-0.75,95%CI-0.96~-0.54,P<0.00001)。结论胆汁回输有利于梗阻性黄疸患者围手术期肝脏功能以及营养状态的恢复,同时缩短术后排气时间以及总住院时间。Objective To systematically evaluate the value of bile reinfusion in clinical treatment of patients with obstructive jaundice.Methods A comprehensive search of the PubMed,Wanfang Database,and China National Knowledge Infrastructure databases from inception up to Sep.7th,2024 was conducted,to identify studies on bile reinfusion following biliary drainage for the reduction of jaundice in patients with obstructive jaundice.Two researchers independently screened the literature,extracted data,and evaluated the quality of the included literature.A meta-analysis was performed using RevMan 5.3 software and Stata 15.0 software.Results This study included a total of 11 articles.The meta-analysis results showed that there was no significant difference in the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),serum albumin(ALB)and prealbumin(PA)between two groups on 1 to 3 days after bile reinfusion(P>0.05).5 days to 1 month after bile reinfusion,ALT and AST levels in the reinfusion group were significantly lower than those in the control group(SMD=-0.35,95%CI-0.51--0.20,P<0.00001;SMD=-0.23,95%CI-0.40--0.06,P=0.007),there was no significant difference in TBil levels between the two groups(P>0.05),and the ALB and PA levels in the reinfusion group were significantly higher than those in the control group(SMD=0.86,95%CI 0.43-1.30,P<0.00001;SMD=0.48,95%CI 0.12-0.84,P=0.009).5 to 7 days after operation,ALT and AST levels in the reinfusion group were significantly lower than those in the control group(SMD=-0.70,95%CI-1.23--0.17,P=0.01;SMD=-0.54,95%CI-1.03--0.05,P=0.03),there was no significant difference in TBil,ALB and PA between the two groups(P>0.05).At 10 days after operation,ALT,AST and TBil levels in the reinfusion group were significantly lower than those in the control group(SMD=-0.38,95%CI-0.59--0.18,P=0.0003;SMD=-0.22,95%CI-0.42--0.01,P=0.04;SMD=-0.58,95%CI-0.82--0.34,P<0.00001),there was no significant difference in PA levels between the two groups(P>0.05).The postoperative exh

关 键 词：梗阻性黄疸 胆汁回输 肝功能 营养指标 

分 类 号：R656[医药卫生—外科学]