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  本文關(guān)鍵詞： 腹腔鏡膽總管探查術(shù) 一期縫合 T管引流 Meta分析　出處：《昆明醫(yī)科大學》2016年碩士論文　論文類型：學位論文

【摘要】：[目的]通過meta分析方法,對腹腔鏡膽總管探查(Laparoscopic common bile duct exploration, LCBDE)取石后膽管一期縫合(Primary closure, PC)與T管引流(T-tube drainage, TD)治療肝外膽管結(jié)石近期臨床療效進行分析評價。[方法]通過計算機檢索CHKD中國醫(yī)院知識倉庫、PubMed、CBM生物醫(yī)學文獻數(shù)據(jù)庫、萬方醫(yī)學網(wǎng)、FMJS外文全文獲取系統(tǒng)、FEBM循證醫(yī)學外文數(shù)據(jù)庫上2005年至2015年12月發(fā)表的,并追索納入文獻的參考文獻,查找國內(nèi)外關(guān)于腹腔鏡膽總管探查膽管一期縫合與T管引流的臨床病例對照研究文獻。根據(jù)納入與排除標準對文獻進行篩選,并對納入文獻進行質(zhì)量評價,提取其中手術(shù)時間、術(shù)中出血量、胃腸道功能恢復時間、術(shù)后住院時間、術(shù)后并發(fā)癥(包括膽漏、膽道殘石、膽道狹窄、膽汁性腹膜炎、切口感染等)的具體數(shù)據(jù)。采用Cochrane協(xié)作網(wǎng)提供的RevMan5.3統(tǒng)計學軟件進行Meta分析。[結(jié)果]按照納入標準,有6項臨床試驗共769病例納入研究。Meta分析結(jié)果顯示,一期縫合組與T管引流組相比較,在手術(shù)時間(WMD 95%CI,-17.44[-27.83,-7.06],P=0.0010)、術(shù)中出血量(WMD 95%CI,-0.54[-0.97,-0.10],P=0.02)、術(shù)后住院時間(WMD 95%CI,-3.06[-3.23,-2.89],P0.00001)、胃腸道功能恢復時間(WMD 95%C1,-14.00[-20.90,-7.09],P0.0001)方面有統(tǒng)計學意義,在術(shù)后并發(fā)癥膽漏(OR=I.15,95%CI：0.54～2.44,P=0.72)、膽道殘石(OR=0.79,95%CI：0.33～1.89,P=0.60)、膽道狹窄(OR=0.58,95%CI：0.08～4.53,P=0.61)、膽汁性腹膜炎(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)方面兩組結(jié)果無統(tǒng)計學意義。[結(jié)論]從本組的資料看來,腹腔鏡下膽總管探查術(shù)膽道一期縫合能減少手術(shù)時間、減少術(shù)中出血量、縮短術(shù)后患者胃腸道功能恢復時間和住院時間,比T管引流有優(yōu)勢,而在術(shù)后并發(fā)癥(包括膽漏、膽道殘石、膽道狹窄、膽汁性腹膜炎、切口感染等)方面兩者之間無統(tǒng)計學意義,故腹腔鏡下膽總管探查膽管一期縫合術(shù)有推廣應用的價值。但由于納入本研究的多樣本偏低,納入的文獻質(zhì)量有限,尚缺乏多中心隨機對照試驗,有待更多合理嚴謹?shù)亩嘀行拇髽颖倦S機對照試驗進一步驗證。
[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.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R657.42

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