腹腔镜下胆总管探查胆管一期缝合与T管引流近期临床疗效对比的meta分析

发布时间：2018-01-27 11:14

本文关键词： 腹腔镜胆总管探查术一期缝合 T管引流 Meta分析　出处：《昆明医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：[目的]通过meta分析方法,对腹腔镜胆总管探查(Laparoscopic common bile duct exploration, LCBDE)取石后胆管一期缝合(Primary closure, PC)与T管引流(T-tube drainage, TD)治疗肝外胆管结石近期临床疗效进行分析评价。[方法]通过计算机检索CHKD中国医院知识仓库、PubMed、CBM生物医学文献数据库、万方医学网、FMJS外文全文获取系统、FEBM循证医学外文数据库上2005年至2015年12月发表的,并追索纳入文献的参考文献,查找国内外关于腹腔镜胆总管探查胆管一期缝合与T管引流的临床病例对照研究文献。根据纳入与排除标准对文献进行筛选,并对纳入文献进行质量评价,提取其中手术时间、术中出血量、胃肠道功能恢复时间、术后住院时间、术后并发症(包括胆漏、胆道残石、胆道狭窄、胆汁性腹膜炎、切口感染等)的具体数据。采用Cochrane协作网提供的RevMan5.3统计学软件进行Meta分析。[结果]按照纳入标准,有6项临床试验共769病例纳入研究。Meta分析结果显示,一期缝合组与T管引流组相比较,在手术时间(WMD 95%CI,-17.44[-27.83,-7.06],P=0.0010)、术中出血量(WMD 95%CI,-0.54[-0.97,-0.10],P=0.02)、术后住院时间(WMD 95%CI,-3.06[-3.23,-2.89],P0.00001)、胃肠道功能恢复时间(WMD 95%C1,-14.00[-20.90,-7.09],P0.0001)方面有统计学意义,在术后并发症胆漏(OR=I.15,95%CI：0.54～2.44,P=0.72)、胆道残石(OR=0.79,95%CI：0.33～1.89,P=0.60)、胆道狭窄(OR=0.58,95%CI：0.08～4.53,P=0.61)、胆汁性腹膜炎(OR=0.22,95%CI：0.04～1.30,P=0.10)、切口感染(OR=0.25,95%CI：0.04～1.53,P=0.13)方面两组结果无统计学意义。[结论]从本组的资料看来,腹腔镜下胆总管探查术胆道一期缝合能减少手术时间、减少术中出血量、缩短术后患者胃肠道功能恢复时间和住院时间,比T管引流有优势,而在术后并发症(包括胆漏、胆道残石、胆道狭窄、胆汁性腹膜炎、切口感染等)方面两者之间无统计学意义,故腹腔镜下胆总管探查胆管一期缝合术有推广应用的价值。但由于纳入本研究的多样本偏低,纳入的文献质量有限,尚缺乏多中心随机对照试验,有待更多合理严谨的多中心大样本随机对照试验进一步验证。
[Abstract]:[Objective] to investigate the laparoscopic common bile duct exploration by meta. Primary closure (PCL) and T-tube drainage were performed after primary suture of bile duct after lithotomy. The clinical effect of TD on extrahepatic cholelithiasis was analyzed and evaluated. [Methods: the CHKD Chinese Hospital knowledge Warehouse (CHKD) was searched by computer to retrieve the CBM biomedical literature database, and the full text acquisition system of FMJS was used in Wanfang Medical Network. FEBM Evidence-based Medicine Foreign language Database was published from 2005 to December 2015. To find domestic and foreign literature on laparoscopic choledochus exploration bile duct primary suture and T-tube drainage clinical case-control study. According to the inclusion and exclusion criteria to screen the literature and to evaluate the quality of the included literature. Extraction of the operation time, intraoperative bleeding, gastrointestinal function recovery time, postoperative hospital time, postoperative complications (including bile leakage, biliary remnant stone, biliary stricture, biliary peritonitis). The specific data of incision infection were analyzed by RevMan5.3 software provided by Cochrane Cooperative Network. [Results: according to the inclusion criteria, 769 cases of 6 clinical trials were included in the study. The results of meta-analysis showed that compared with T-tube drainage group, the primary suture group had WMD 95CI in the operation time. -17.44. [-27.83% -7.06] (P < 0.0010), intraoperative bleeding volume: WMD 95: CI-0.54. [After operation, the hospital stay was longer than WMD 95 and CI-3.06. [P0.00001, Gastrointestinal function recovery time: WMD 95 / -14.00. [There was statistical significance in the postoperative complications, ORI.151.95 CI: 0.54 / 2.44 (P = 0.0001, P = 0.0001, P = 0.090, P = 7.09, P = 0.0001, P = 0.54, P = 0.0001, P = 0.0001). P0. 72%, Bile duct Stones were 0. 79 + 95% CI: 0. 33, 1. 89, P0. 60, and 0. 58 for stricture of bile duct. 95 CI: 0.08% 4.53% P0. 61, bile peritonitis 0.22% 0. 22% 0. 95% 1. 30% P0. 10). There was no significant difference between the two groups in the two groups. [Conclusion: according to the data of this group, the primary suture of common bile duct exploration under laparoscope can reduce the operation time, reduce the amount of intraoperative bleeding, shorten the postoperative gastrointestinal function recovery time and hospitalization time. There was no significant difference in postoperative complications (including bile leakage, biliary remnant stone, biliary stricture, biliary peritonitis, incision infection, etc.). Therefore laparoscopic choledochus exploration for primary suture of bile duct has the value of popularization but due to the low number of samples included in this study and the limited quality of the literature there is still a lack of multicenter randomized controlled trial. More reasonable and rigorous randomized controlled trials of large-scale multi-center samples are needed to be further verified.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R657.42

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