肝切除术后不放置腹腔引流管的安全性与有效性Meta分析

doi:10.3877/cma.j.issn.2095-3232.2017.06.013

目的

评价肝切除术后不放置腹腔引流管的安全性及有效性。

方法

计算机检索PubMed、Embase、Cochrane Library、Google Scholar、Web of Science、中国生物医学文献数据库、维普网、中国知网及万方数据库2016年6月之前发表的关于肝切除术后不放置腹腔引流管的随机对照试验。由两名研究人员根据纳入与排除标准独立地进行文献筛选、数据提取和方法学质量评价。异质性研究采用固定效应模型Meta分析，同质性研究采用随机效应模型Meta分析。

结果

最终纳入6篇文献，共665例患者，其中不放置腹腔引流管组331例，放置腹腔引流管组334例。Meta分析结果显示，与放置腹腔引流管组比较，不放置腹腔引流管组死亡、腹腔感染、腹腔积液、胆漏、伤口感染、肺部感染与再次手术的不良事件发生率差异无统计学意义（RR=0.86，0.51，0.66，0.60，0.58，0.85，0.75；P>0.05）。两组术后住院时间比较差异无统计学意义（WMD=0.40，P>0.05）。

结论

肝切除术后常规放置腹腔引流管可能并无必要。

关键词: 肝切除术, 引流术, Meta分析, 手术后并发症

Objective

To evaluate the safety and effectiveness of nonuse of abdominal drainage after hepatectomy.

Methods

PubMed, Embase, Cochrane Library, Google Scholar, Web of Science, CBM, VPW, CNKI and Wanfang Database were searched for relevant randomized controlled trials about nonuse of abdominal drainage after hepatectomy published before June 2016. Literature screening, data extraction, and methodological quality evaluation were independently conducted by two investigators based on the inclusion and exclusion criteria. Heterogeneity study was performed by Meta analysis of fixed effect model and homogeneity study was performed by Meta analysis of random effect model.

Results

A total of 6 papers, 665 patients were included, including 331 patients in no abdominal drainage group and 334 patients in abdominal drainage group. The Meta-analysis results showed that there was no significant difference between no abdominal drainage group and abdominal drainage group in the mortality, incidence of abdominal infection, abdominal effusion, bile leakage, wound infection, pulmonary infection and reoperation (RR=0.86, 0.51, 0.66, 0.60, 0.58, 0.85, 0.75; P>0.05). In addition, there was no significant difference between both groups in the length of postoperative hospital stay (WMD=0.40, P>0.05).

Conclusion

Conventional abdominal drainage may not be necessary for patients after hepatectomy.

Key words: Hepatectomy, Drainage, Meta-analysis, Postoperative complications

表1 纳入研究的文献方法学质量评价

作者	随机方法	分配隐藏	盲法	退出或失访	选择性报告	其他偏倚	质量等级
Fuster等^[7]	是	是	否	不清楚	不清楚	不清楚	中
Belghiti等^[14]	是	否	否	是	是	不清楚	中
Fong等^[15]	是	是	否	不清楚	不清楚	不清楚	中
Liu等^[16]	是	是	否	是	否	不清楚	高
Sun等^[17]	是	是	否	不清楚	不清楚	不清楚	中
Kim等^[18]	是	否	否	是	是	不清楚	中

表1 纳入研究的文献方法学质量评价

作者	随机方法	分配隐藏	盲法	退出或失访	选择性报告	其他偏倚	质量等级
Fuster等^[7]	是	是	否	不清楚	不清楚	不清楚	中
Belghiti等^[14]	是	否	否	是	是	不清楚	中
Fong等^[15]	是	是	否	不清楚	不清楚	不清楚	中
Liu等^[16]	是	是	否	是	否	不清楚	高
Sun等^[17]	是	是	否	不清楚	不清楚	不清楚	中
Kim等^[18]	是	否	否	是	是	不清楚	中

图1 肝切除术后放置与不放置腹腔引流管患者死亡率比较Meta分析森林图

图2 肝切除术后放置与不放置腹腔引流管患者腹腔感染发生率Begg漏斗图

图3 肝切除术后放置与不放置腹腔引流管患者住院时间比较Meta分析森林图

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Safety and effectiveness of nonuse of abdominal drainage after hepatectomy: a Meta analysis

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Safety and effectiveness of nonuse of abdominal drainage after hepatectomy: a Meta analysis