胆总管探查术后一期缝合与留置T管引流的对比分析

目的系统评价比较胆总管探查术后胆管一期缝合（PC）与留置T管引流（TD）的疗效与安全性。方法计算机及手工检索相关文献,纳入比较PC与TD的随机对照试验进行系统评价。结果共纳入6个研究进行分析,合计415例患者。Meta分析显示：与留置T管引流组比较,胆管一期缝合组在围术期死亡率、术后胆漏及结石残留发生率上无显著差异性（P〉0．05）,但在术后伤口感染及主要并发症发生率、住院时间上有明显优势（P〈0．05）。结论Meta分析提示,胆总管探查术后胆管一期缝合能缩短住院时间,降低术后部分并发症发生几率,值得推广运用。但由于存在纳入研究较少、总体质量不高等易致偏倚的因素,影响论证真实性,期待更多高质量的多中心临床随机对照试验进一步验证。

The comparison of primary closure with T - tube drainage after common bile duct exploration

Objective To compare the benefits and harms of primary closure versus T - tube drainage after common bile duct exploration for eholedocholithiasis. Methods Searched out all the randomized controlled trials confirmed to assess the benefits and harms of primary closure versus T - tube drainage after common bile duct exploration. Results A total of 6 trials involving 415 patients were included. The result of metaanalysis showed that the primary closure group was with a lower risk of wound infection, major complications, and a shorter hospital stay （ P 〈 0. 05 ） , while no statistically significant differences were observed between the two groups on peri - operative mortality, the incidence of bile leakage and residual stones（P 〉 0. 05）. Conclusion The present study shows that the primary closure after choledoehotomy might be an effective method in the prevention of the development of post - operative complications. Multi - factors such as few quantity and low quality of included studies which lead to bias affected the authenticity of our review, so further large - scale trials are required.