单向倒刺线与传统缝线在腹腔镜胆总管一期缝合术中应用比较的Meta分析
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摘要
目的:比较腹腔镜胆道探查术后胆总管一期缝合术中采用单向倒刺线(UBS)与传统缝线(TS)的临床效果。方法:检索中英文数据库中比较UBS与TS在腹腔镜胆道探查胆总管一期缝合术中应用的临床研究,检索时间最后为2018年9月。在对纳入研究进行方法学质量评价和数据提取后,采用RevMan5.1和STATA12.0软件行Meta分析。结果:最终纳入10个研究,包括3个随机对照研究(RCT)和7个观察性研究,共848例患者。整体分析显示,与TS组比较,UBS组胆管缝合时间(WMD=-11.38,95%CI=-14.81～-7.94,P<0.001),手术时间(WMD=-20.55,95%CI=-30.63～-10.46,P<0.001)和住院时间(WMD=-0.78,95%CI=-1.47～-0.09,P<0.05)均明显缩短,术后胆汁漏发生率明显降低(RR=0.23,95%CI=0.10～0.55,P<0.001)。基于研究设计的亚组分析结果显示,两组除住院时间在RCT研究中无统计学差异(WMD=-0.06,95%CI=-0.61～0.49,P=0.83),其余均与整体分析结果一致。结论:UBS不仅为腹腔镜胆总管一期缝合提供了一个新途径,且安全可行。未来还需要更多的多中心大样本随机对照试验来予以验证。
Objective: To compare the clinical efficacy of using unidirectional barbed suture(UBS) and traditional suture(TS) in primary closure of the common bile duct following laparoscopic common bile duct exploration(LCBDE). Methods: The clinical studies comparing using UBS and TS in LCBDE with primary choledochal closure published in English and Chinese were searched through online databases. The retrieval time was up to September 2018. After the quality evaluation and data extraction of the included studies, Meta-analysis was performed by using RevMan 5.1 and STATA 12.0 software.Results: Ten studies were finally included with three randomized controlled trials(RCTs) and seven observational studies, involving a total of 848 patients. The results of overall analysis showed that the time for bile duct suturing(WMD=–11.38, 95% CI=–14.81––7.94, P<0.001), operative time(WMD=–20.55, 95% CI= –30.63––10.46, P<0.001) and length of hospital stay(WMD=–0.78, 95% CI=–1.47––0.09, P<0.05) were all shortened, and the incidence of bile leakage(RR=0.23, 95% CI=0.10–0.55, P<0.001) was decreased significantly in UBS group compared with TS group. The results of subgroup analyses based on study design showed that except the length of hospital stays had no statistical difference between the two groups(WMD=–0.06, 95% CI=–0.61–0.49, P=0.83), all the others were consistent with the results of overall analysis. Conclusion: UBS not only provides a new approach for laparoscopic primary choledochal closure, but also is feasible and safe. However, this conclusion still needs to be verified by more multicenter and well-designed randomized controlled trials.
Objective: To compare the clinical efficacy of using unidirectional barbed suture(UBS) and traditional suture(TS) in primary closure of the common bile duct following laparoscopic common bile duct exploration(LCBDE). Methods: The clinical studies comparing using UBS and TS in LCBDE with primary choledochal closure published in English and Chinese were searched through online databases. The retrieval time was up to September 2018. After the quality evaluation and data extraction of the included studies, Meta-analysis was performed by using RevMan 5.1 and STATA 12.0 software.Results: Ten studies were finally included with three randomized controlled trials(RCTs) and seven observational studies, involving a total of 848 patients. The results of overall analysis showed that the time for bile duct suturing(WMD=–11.38, 95% CI=–14.81––7.94, P<0.001), operative time(WMD=–20.55, 95% CI= –30.63––10.46, P<0.001) and length of hospital stay(WMD=–0.78, 95% CI=–1.47––0.09, P<0.05) were all shortened, and the incidence of bile leakage(RR=0.23, 95% CI=0.10–0.55, P<0.001) was decreased significantly in UBS group compared with TS group. The results of subgroup analyses based on study design showed that except the length of hospital stays had no statistical difference between the two groups(WMD=–0.06, 95% CI=–0.61–0.49, P=0.83), all the others were consistent with the results of overall analysis. Conclusion: UBS not only provides a new approach for laparoscopic primary choledochal closure, but also is feasible and safe. However, this conclusion still needs to be verified by more multicenter and well-designed randomized controlled trials.
引文
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