摘要
目的比较腹腔镜胆总管切开取石(laparoscopic common bile duct exploration,LCBDE)、一期缝合术(primary duct closure,PDC)中倒刺线缝合(barbed suture,BS)、可吸收缝线连续缝合(continuous su⁃ture,CS)及可吸收缝线间断缝合(interrupted suture,IS)三种缝合方式间胆漏发生率和胆管缝合时间的差异。方法检索Pubmed、Web of science、Embase、中国知网(China National Knowledge Infrastructure,CNKI)及万方数据库中的相关文献,利用Review Manager 5.4.1和GeMTC 0.14.3软件进行直接Meta分析和网状Meta分析。结果共纳入队列研究13项,随机对照研究1项以及半随机对照研究1项,合计纳入1569例患者。网状Meta分析显示在胆漏发生率方面,BS与CS胆漏发生率低于IS[BS⁃IS:OR=0.32(0.16,0.62),P<0.05][CS⁃IS:OR=0.37(0.14,0.94),P<0.05],BS与CS间无差异[OR=0.86(0.35,2.02),P>0.05]。概率排序结果表明胆漏发生率BS<CS<IS。在胆管缝合时间方面,BS胆管缝合时间短于IS[MD=-15.12(-22.06,-8.21),P<0.05],但BS与CS、CS与IS间均无差异[BS⁃CS:MD=-7.24(-15.32,0.75),P>0.05][CS⁃IS:MD=-7.84(-17.51,1.41),P>0.05],概率排序结果表明胆管缝合时间BS<CS<IS。结论BS与CS在预防术后胆漏方面较IS更安全;同时BS在减少胆管缝合时间方面优于IS。
Objective To compare the incidence of postoperative bile leakage and bile duct closure time between barbed suture(BS),continuous suture with absorbable thread(CS)and interrupted suture with absorbable thread(IS)in primary duct closure(PDC)after laparoscopic common bile duct exploration(LCBDE).Methods Pubmed,Web of science,Embase,China National Knowledge Infrastructure(CNKI)and Wanfang Database were searched for relevant literature.Review Manager 5.4.1 and GeMTC 0.14.3 software were used for meta-analysis and network meta-analysis.Results A total of 13 cohort studies,1 randomized controlled trial(RCT)study and 1 semi-randomized controlled study were included,with 1569 patients in total.Network meta-analysis showed that the incidence of bile leakage in BS and CS was lower than that in IS[BS-IS:OR=0.32(0.16,0.62),P<0.05][CS-IS:OR=0.37(0.14,0.94),P<0.05].There was no significant difference between BS and CS[OR=0.86(0.35,2.02),P>0.05].The results of probability ranking showed that the incidence of bile leakage was BS<CS<IS.In terms of bile duct closure time,BS was shorter than IS[MD=-15.12(-22.06,-8.21),P<0.05],but there was no significant difference between BS and CS,CS and IS[BS-CS:MD=-7.24(-15.32,0.75),P>0.05][CS-IS:MD=-7.84(-17.51,1.41),P>0.05],probability ranking results showed that the bile duct suture time was BS<CS<IS.Conclusion BS and CS are safer than IS in preventing postoperative bile leaks,while BS is superior to IS in reducing bile duct suture time.
作者
滕跃
纪道林
任稣萍
裴宏宇
谭刚
TENG Yue;JI Dao-lin;REN Su-ping;PEI Hong-yu;TAN Gang(Department of General Surgery,The Fourth Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Department of Regulation of Energy Homeostasis Research,Health Sciences Institute of China Medical University,Shenyang 110122,China)
出处
《哈尔滨医科大学学报》
CAS
2024年第2期214-220,共7页
Journal of Harbin Medical University
基金
国家自然科学基金青年基金项目(82102911)
黑龙江省自然科学基金优秀青年项目(YQ2022H011)
哈尔滨医科大学附属第四医院优秀青年项目(HYDSYYXQN202301、HYDSYYXQN202102)
作者简介
滕跃(1994-),男,住院医师,硕士;通讯作者:谭刚,E-mail:tangang@hrbmu.edu.cn
