腹腔镜胆总管探查取石术后胆管一期缝合与T管引流比较的系统评价

目的系统评价腹腔镜下胆总管探查取石后胆管一期缝合(LBEPS)与腹腔镜下胆总管探查取石后T管引流(LCHTD)治疗胆总管结石的效果,为医患双方合理选择术式提供证据。方法计算机检索Cochrane图书馆临床对照试验数据库(2010年第2期)、PubMed(1978～2010)、EMbase(1966～2010)、CBM(1978～2010)、CNKI(1979～2010)和中华医学会数字化期刊系统(1990～2010),并手工检索中、英文已发表的资料和会议论文并追索纳入文献的参考文献,查找比较LBEPS与LCHTD治疗胆总管结石的随机或半随机对照试验。在对纳入研究进行方法学质量评价后,采用RevMan 5.0软件进行Meta分析。结果共纳入3个随机对照试验和1个半随机对照试验,合计274例患者。Meta分析结果表明:与LCHTD相比,LBEPS能缩短手术时间WMD=–17.11,95%CI(–25.86,–8.36)]、腹腔引流时间WMD=–0.74,95%CI(–1.39,–0.10)]、术后住院天数WMD=–3.30,95%CI(–3.67,–2.92)]和减少住院费用WMD=–2998.75,95%CI(–4396.24,–1601.26)],而且还能降低由放置T管引起的脱管及拔管后胆漏、胆汁性腹膜炎等并发症的发生RR=0.56,95%CI(0.29,1.09)]。结论 LBEPS治疗胆总管结石总体疗效优于与LCHTD,其前提是需严格掌握手术适应症。由于纳入研究质量普遍较低,上述结论尚需开展更多设计合理、执行严格的多中心大样本且随访时间足够的随机对照试验加以验证。

Primary Suture versus T-tube Drainage after Laparoscopic Common Bile Duct Stone Exploration: A Systematic Review

Objective To assess the benefits and harms of routine primary suture(LBEPS) versus T-tube drainage(LCHTD) following laparoscopic common bile duct stone exploration.Methods The randomized controlled trials(RCTs) or quasi-RCTs were electronically searched from the Cochrane Controlled Trials Register(The Cochrane Library,Issue 2,2010),PubMed(1978 to 2010),EMbase(1966 to 2010),CBMdisc(1978 to 2010),and CNKI(1979 to 2010);and the relevant published and unpublished data and their references were also searched by ...