腹腔镜胆总管探查胆管一期缝合与T管引流的Meta分析

Primary closure versus T-tube drainage in laparoscopic common bile duct exploration：a Meta analysis

摘要:

目的：系统评价腹腔镜胆总管探查（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）治疗胆总管结石的临床疗效。方法：检索Cochrane Library、PubMed、EMbase、中国生物医学、中国期刊全文等数据库，查找2000-2012年发表的关于LCBDE取石后ＰＣ与ＴＤ治疗胆总管结石的文献资料，进行 Meta 分析。结果：共纳入5篇文献，合计572例患者。Meta分析结果显示，ＬＣＢＤＥ取石后ＰＣ与ＴＤ相比，在胆道相关并发症发生率上无统计学差异（RR=0.87，95%CI[0.46，1.63]，P=0.66），但在手术时间（WMD=-28.66，95%CI[-34.00，-23.32]，P<0.000 01）、术后住院时间（WMD=-3.03，95%CI[-3.85，-2.47]，P<0.000 01）、总并发症发生率（RR=0.55，95%CI[0.34，0.89]，P=0.01）等方面明显减少。结论：ＬＣＢＤＥ取石后PC安全有效，可作为治疗胆总管结石的有效方法。

Abstract:

Objective：To systematically evaluate the efficacy of primary closure（PC） versus T-tube drainage（TD） in laparoscopic common bile duct exploration（LCBDE） in the treatment of choledocholithiasis. Methods：Clinical trials，which compared the effi－cacy of PC versus TD LCBDE in the treatment of choledocholithiasis were electronically searched from the Cochrane Library，PubMed，EMbase，CBM，CNKI data bases from 2000 to 2012 and the RevMan 5.0 software was used for data analysis. Results：Five trials with 572 patients were included. Meta-analysis revealed that there was no significant difference in incidences of biliary related complications between PC and TD groups（RR=0.87，95%CI[0.46，1.63]，P=0.66）. Operating time（WMD=-28.66，95%CI[-34.00，-23.32]，P<0.000 01），postoperative hospitalization duration（WMD=-3.03，95%CI[-3.85，-2.47]，P<0.000 01） and total complication incidences（RR=0.55，95%CI[0.34，0.89]，P=0.01） were decreased in PC group compared with those in TD group. Conclusions：PC in LCBDE is safe and effective；it is a preferred option in the treatment of choledocholithiasis.