腹腔镜胆总管探查后胆道支架引流与T管引流疗效比较的Meta分析

doi:10.7659/j.issn.1005-6947.2023.02.001

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腹腔镜胆总管探查后胆道支架引流与T管引流疗效比较的Meta分析
DOI:
                        10.7659/j.issn.1005-6947.2023.02.001
                    
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作者单位:中国人民解放军联勤保障部队第九〇四医院 普通外科，江苏 无锡 214000
作者简介:徐健，中国人民解放军联勤保障部队第九〇四医院主治医师，主要从事胃肠肿瘤外科方面的研究。
通信作者:余锋，Email: reyufeng101@163.com
基金项目:

Efficacy comparison of biliary drainage stenting and T-tube drainage after laparoscopic common bile duct exploration: a Meta-analysis

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Department of General Surgery, the 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu 214000, China

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摘要:

背景与目的 腹腔镜胆总管探查术（LCBDE）是治疗胆总管结石的最常用手术方式，但LCBDE术后胆总管缝合方式仍存在较大争议。胆道内支架引流（BDS）是近年来应用较多的胆总管缝合术式，与传统T管引流术式相比，具有可一期缝合和避免术后长期体外留置T管的优点。因此，本研究通过Meta分析比较LCBDE后BDS和T管引流两种术式的临床疗效，探讨BDS术式的临床应用价值。方法检索多个国内外文献数据库收集比较LCBDE术后行BDS与T管引流疗效的临床研究。检索时间为2010年1月1日至2022年1月1日。结局指标包括手术时间、手术失血量、术后排气时间、术后去除引流管时间、住院时间、胆汁漏及总体并发症发生率。用Revman 5.4软件进行Meta分析。结果共纳入符合标准的文献11篇，5篇为随机对照研究，6篇为回顾性队列研究，文献累计样本量为1 140例，BDS组561例和T管引流组579例。Meta分析结果显示，两组的手术时间（WMD=-4.60，95% CI=-10.01~0.81，P=0.10）、失血量（WMD=-0.66，95% CI=-2.12~0.79，P=0.37）差异无统计学意义；BDS组的术后排气时间（WMD=-8.99，95% CI=-13.60~-4.39，P=0.000 1）、术后胆汁漏（OR=0.37，95% CI=0.17~0.78，P=0.009）与总体并发症发生率（OR=0.41，95% CI=0.23~0.73，P=0.002）、拔除引流管时间（WMD=-1.33，95% CI=-2.47~-0.19，P=0.02）、住院时间（WMD=-3.79，95% CI=-5.24~-2.35，P<0.000 01）方面优于T管引流组。结论具有适应证的胆总管结石患者，LCBDE术后行BDS可加速术后康复、降低胆总管缝合相关并发症，是一种安全且有一定临床应用价值术式。

Abstract:

Background and Aims Laparoscopic common bile duct exploration (LCBDE) is the most commonly used surgical procedure for the treatment of common bile duct stones, but the methods for suture of the common bile duct after LCBDE remain controversial. Biliary drainage stenting (BDS) is a suture technique of the common bile duct and has been widely used in recent years. Compared with the traditional T-tube drainage, BDS has the advantages of primary closure and avoidance of the long-term placement of T-tube after surgery. Therefore, this study was conducted to evaluate the clinical application value of BDS by comparing the clinical efficacy of BDS and T-tube drainage following LCBDE through a Meta-analysis.Methods The clinical studies comparing BDS and T-tube drainage following LCBDE were collected by searching several national and international literature databases. The retrieval time was set from January 1, 2010 to January 1, 2022. The outcome variables included operative time, blood loss, time to anal gas passage, time to abdominal drainage tube removal, length of hospitalization and incidence rates of bile leakage and overall complications. Meta-analysis was performed using Revman 5.4 software.Results A total of 11 studies meeting the inclusion criteria were selected, including 5 randomized controlled trials and 6 retrospective cohort studies, involving 1 140 patients, with 561 cases in BDS group and 579 cases in T-tube drainage group. The results of Meta-analyses showed that there was no significant difference in operative time (WMD=-4.60, 95% CI=-10.01-0.81, P=0.10) and blood loss (WMD=-0.66, 95% CI=-2.12-0.79, P=0.37) between the two groups, but BDS group was superior to control group in terms of time to postoperative gas passage (WMD=-8.99， 95% CI=-13.60--4.39， P=0.000 1), incidence rates of bile leakage (OR=0.37, 95% CI=0.17-0.78, P=0.009) and overall complications (OR=0.41, 95% CI=0.23-0.73, P=0.002), time to abdominal drainage tube removal (WMD=-1.33, 95% CI=-2.47--0.19, P=0.02) and length of hospital stay (WMD=-3.79, 95% CI=-5.24- -2.35, P<0.000 01).Conclusion For indicated patients with common bile duct stones, BDS suture after LCBDE can accelerate the postoperative recovery and reduce the complications associated with suture of the common bile duct. So, it is a safe procedure with certain clinical application value.