切换至 "中华医学电子期刊资源库"
高级检索
中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2023, Vol. 12 ›› Issue (05) : 545 -550. doi: 10.3877/cma.j.issn.2095-3232.2023.05.014

临床研究

腹腔镜胆总管探查术一期缝合术后胆漏危险因素Meta分析
杨海龙, 邓满军†(), 樊羿辰, 徐梦钰, 陈芳德, 吴威浩, 张生元   
  1. 810003　西宁市第二人民医院普通外科
    810012　西宁，青海大学附属医院肝胆胰外科
  • 收稿日期:2023-06-25 出版日期:2023-10-10
  • 通信作者: 邓满军
  • 基金资助:
    西宁市科学技术局项目(2016-k-22)

Risk factors of bile leakage after primary suture of laparoscopic common bile duct exploration: a Meta-analysis

Hailong Yang, Manjun Deng†(), Yichen Fan, Mengyu Xu, Fangde Chen, Weihao Wu, Shengyuan Zhang   

  1. Department of General Surgery, the Second People's Hospital of Xining, Xining 810003, China
    Department of Hepatobiliary and Pancreatic Surgery, Qinghai University Affiliated Hospital, Xining 810012, China
  • Received:2023-06-25 Published:2023-10-10
  • Corresponding author: Manjun Deng
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

杨海龙, 邓满军, 樊羿辰, 徐梦钰, 陈芳德, 吴威浩, 张生元. 腹腔镜胆总管探查术一期缝合术后胆漏危险因素Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 545-550.

Hailong Yang, Manjun Deng, Yichen Fan, Mengyu Xu, Fangde Chen, Weihao Wu, Shengyuan Zhang. Risk factors of bile leakage after primary suture of laparoscopic common bile duct exploration: a Meta-analysis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(05): 545-550.

目的

探讨腹腔镜胆总管探查术（LCBDE）一期缝合术后胆漏的危险因素。

方法

检索PubMed、Embase、Cochrane Library、Web of Science、知网、万方、维普等数据库1990年1月1日至2022年5月1日关于LCBDE一期缝合术后胆漏危险因素的临床研究。中文检索词：胆总管结石、腹腔镜胆总管探查、胆漏、危险因素。英文检索词：choledocholithiasis、common bile duct stone、laparoscopic common bile duct exploration、LCBDE、bile leakage。对研究报道数量≥3的指标进行Meta分析。

结果

最终纳入7项研究共930例患者，其中男431例，女499例。Meta分析结果显示，术前血ALB<35 g/L的患者术后胆漏发生率明显高于术前血ALB≥35 g/L的患者（OR=2.23，95%CI：1.16~4.28）；术中胆总管切开长度<1.5 cm的患者术后胆漏发生率明显低于切开长度≥1.5 cm的患者（OR=0.42，95%CI：0.20~0.87）；胆总管连续缝合患者术后胆漏发生率明显低于间断缝合患者（OR=0.51，95%CI：0.29~0.90）；胆总管直径<1 cm的患者术后胆漏发生率明显高于胆总管直径≥1 cm的患者（OR=4.00，95%CI：2.23~7.17）。

结论

选择胆总管直径<1 cm患者，术前纠正血ALB水平，术中切开胆总管长度控制1.5 cm以内，切口采用连续缝合可有效降低LCBDE一期缝合术后胆漏发生风险。

关键词: 腹腔镜胆总管探查, 一期缝合, 胆漏, 危险因素, Meta分析
Objective

To investigate the risk factors of bile leakage after primary duct suture of laparoscopic common bile duct exploration (LCBDE).

Methods

Clinical studies related to the risk factors of bile leakage after primary suture of LCBDE were searched from PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data and Chongqing VIP from January 1, 1990 to May 1, 2022. The Chinese searching words included common bile duct stone, laparoscopic common bile duct exploration, bile leakage and risk factor. The English searching words consisted of choledocholithiasis, common bile duct stone, laparoscopic common bile duct exploration, LCBDE and bile leakage. The indexes which were reported in ≥3 clinical studies were subject to Meta-analysis.

Results

7 studies of 930 patients were finally selected, including 431 male and 499 female. Meta-analysis showed that the incidence of postoperative bile leakage in patients with preoperative albumin (ALB) level of <35 g/L was significantly higher than that in their counterparts with preoperative ALB level of ≥35 g/L (OR=2.23, 95%CI: 1.16-4.28). The incidence of postoperative bile leakage in patients with common bile duct incision length of <1.5 cm during operation was significantly lower than that in those with a length of ≥1.5 cm (OR=0.42, 95%CI: 0.20-0.87). The incidence of postoperative bile leakage in patients receiving continuous suture of common bile duct was significantly lower than that in those treated with interrupted suture (OR=0.51, 95%CI: 0.29-0.90). The incidence of postoperative bile leakage in patients with common bile duct diameter of <1 cm was significantly higher than that in their counterparts with common bile duct diameter of ≥1 cm (OR=4.00, 95%CI: 2.23-7.17).

Conclusions

Selecting patients with common bile duct diameter of <1 cm, correcting ALB level before operation, maintaining the common bile duct incision length of within 1.5 cm during operation and adopting continuous suture can effectively reduce the risk of bile leakage after primary suture of LCBDE.

Key words: Laparoscopic common bile duct exploration, Primary duct closure, Bile leakage, Risk factors, Meta-analysis
表1 LCBDE一期缝合术后胆漏危险因素Meta分析文献的基本特征及质量评价
第一作者 年份 样本量（例） 男/女（例） 胆漏（例） NOS评分
饶尚锐[10] 2007 115 55/60 10 5
刘学礼[11] 2016 82 46/36 8 7
段宁[12] 2017 154 79/75 18 6
Liu[13] 2017 141 72/69 16 8
张鸣杰[14] 2020 92 29/63 11 6
汤海波[15] 2020 200 92/108 44 7
付振东[16] 2021 146 58/88 14 7
图1 LCBDE一期缝合术后胆漏危险因素Meta分析森林图注：LCBDE为腹腔镜胆总管探查术
表2 LCBDE一期缝合术后胆漏危险因素的Meta分析结果
因素 异质性检验 Meta分析 Egger's检验
I2 P OR 95%CI t P
性别 0 0.83 0.83 0.55~1.26 -0.51 0.64
年龄 0 0.99 0.78 0.43~1.41 0.24 0.84
术前ASA分级 0 0.61 0.59 0.32~1.10 3.08 0.09
术前血WBC水平 0 0.44 0.98 0.47~2.03 0.17 0.88
术前血TB水平 0 0.48 1.63 0.94~2.82 0.76 0.53
糖尿病 44% 0.13 1.09 0.57~2.09 -0.96 0.41
胆囊结石 0 0.98 0.91 0.42~1.01 2.96 0.21
胆总管结石数量 0 0.68 0.85 0.43~1.70 9.01 0.07
术中出血量 5% 0.37 1.46 0.71~3.00 1.39 0.29
[8]
Deng M, Yan J, Zhang Z, et al. Greater than or equal to 8 mm is a safe diameter of common bile duct for primary duct closure: single-arm meta-analysis and systematic review[J]. Clin J Gastroenterol, 2022, 15(3):513-521.
[9]
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9):603-605.
[10]
饶尚锐, 潘忠良, 石铮. 腹腔镜胆总管一期缝合术后胆漏的多因素分析——血浆白蛋白水平是胆漏发生的独立危险因素[J]. 中国微创外科杂志, 2013, 13(11):982-984.
[11]
刘学礼, 吴卫国, 张玉豹, 等. 胆总管一期缝合治疗胆总管结石疗效及术后胆漏危险因素分析[J]. 肝胆胰外科杂志, 2017, 29(3):196-199, 202.
[12]
段宁, 刘东斌, 曹锋, 等. 腹腔镜胆总管探查一期缝合术后胆漏的危险因素分析[J]. 临床外科杂志, 2017, 25(12):914-918.
[13]
Liu D, Cao F, Liu J, et al. Risk factors for bile leakage after primary closure following laparoscopic common bile duct exploration: a retrospective cohort study[J]. BMC Surg, 2017, 17(1):1.
[14]
张鸣杰, 曹国良, 孙旭, 等. 腹腔镜胆总管探查一期缝合术后胆瘘及胆总管狭窄的危险因素分析[J]. 肝胆胰外科杂志, 2020, 32(1):13-18.
[15]
汤海波, 琚然. 腹腔镜胆总管切开取石一期缝合治疗胆总管结石术后胆漏发生的危险因素研究[J]. 腹部外科, 2020, 33(4):306-310.
[16]
付振东, 上官建营, 肖毅, 等. 腹腔镜胆总管探查一期缝合术后胆漏的分析[J]. 西北国防医学杂志, 2021, 42(5):356-360.
[17]
Zhu J, Tu S, Yang Z, et al. Laparoscopic common bile duct exploration for elderly patients with choledocholithiasis: a systematic review and meta-analysis[J]. Surg Endosc, 2020, 34(4):1522-1533.
[18]
Li M, Tao Y, Shen S, et al. Laparoscopic common bile duct exploration in patients with previous abdominal biliary tract operations[J]. Surg Endosc, 2020, 34(4):1551-1560.
[19]
Joshi MR, Sharma SK. Laparoscopic primary repair of common bile duct: does the suture size matter[J]. J Nepal Health Res Counc, 2011, 9(1):10-13.
[20]
刘雷, 张永玺, 谢伟峰, 等. 单向倒刺线在腹腔镜胆总管一期缝合中的应用[J]. 肝胆胰外科杂志, 2020, 32(11):690-692, 705.
[21]
Jie Z, Hong L, Shaocheng Z, et al. A study of primary single and layered suture technique by using two-port laparoscopic choledocholithotomy[J]. J Minim Access Surg, 2019, 15(4):311-315.
[22]
吴鹏, 方路, 高夫生, 等. 腹腔镜下胆总管切开取石一期缝合术的学习曲线[J]. 山东医药, 2017, 57(21):53-55.
[1]
中华医学会外科学分会胆道外科学组，中国医师协会外科医师分会胆道外科医师委员会. 胆囊良性疾病外科治疗的专家共识(2021版)[J]. 中华外科杂志, 2022, 60(1):4-9.
[2]
Dasari BV, Tan CJ, Gurusamy KS, et al. Surgical versus endoscopic treatment of bile duct stones[J]. Cochrane Database Syst Rev, 2013(12):D3327.
[3]
姜永斌, 梁斌, 郑娇娇, 等. 腹腔镜胆总管探查治疗胆总管结石158例临床分析[J]. 中国医学科学院学报, 2022, 44(2):286-289.
[4]
朱斯维, 尹新民. 肝胆管结石腔镜手术的决策与要点[J]. 肝胆外科杂志, 2021, 29(2):81-83, 122.
[5]
王垒, 黄鑫, 邓满军, 等. 贝叶斯网状Meta分析预测腹腔镜胆总管探查术后胆道内支架引流与单纯一期缝合的临床疗效[J]. 中华消化外科杂志, 2020, 19(8):849-855.
[6]
Ricci C, Pagano N, Taffurelli G, et al. Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: a systematic review and network meta-analysis[J]. JAMA Surg, 2018, 153(7):e181167.
[7]
Zhu T, Lin H, Sun J, et al. Primary duct closure versus T-tube drainage after laparoscopic common bile duct exploration: a meta-analysis[J]. J Zhejiang Univ Sci B, 2021, 22(12):985-1001.
[1] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[2] 马艳波, 华扬, 刘桂梅, 孟秀峰, 崔立平. 中青年人颈动脉粥样硬化病变的相关危险因素分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 822-826.
[3] 黄应雄, 叶子, 蒋鹏, 詹红, 姚陈, 崔冀. 急性肠系膜静脉血栓形成致透壁性肠坏死的临床危险因素分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 413-421.
[4] 李雄雄, 周灿, 徐婷, 任予, 尚进. 初诊导管原位癌伴微浸润腋窝淋巴结转移率的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 466-474.
[5] 张再博, 王冰雨, 焦志凯, 檀碧波. 胃癌术后下肢深静脉血栓危险因素的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 475-480.
[6] 陈旭渊, 罗仕云, 李文忠, 李毅. 腺源性肛瘘经手术治疗后创面愈合困难的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 82-85.
[7] 唐旭, 韩冰, 刘威, 陈茹星. 结直肠癌根治术后隐匿性肝转移危险因素分析及预测模型构建[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 16-20.
[8] 吴方园, 孙霞, 林昌锋, 张震生. HBV相关肝硬化合并急性上消化道出血的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 45-47.
[9] 毛永欢, 仝瀚文, 缪骥, 王行舟, 沈晓菲, 喻春钊. 造口旁疝危险因素预测模型构建[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 682-687.
[10] 陆猛桂, 黄斌, 李秋林, 何媛梅. 蜂蛰伤患者发生多器官功能障碍综合征的危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1010-1015.
[11] 李达, 张大涯, 陈润祥, 张晓冬, 黄士美, 陈晨, 曾凡, 陈世锔, 白飞虎. 海南省东方市幽门螺杆菌感染现状的调查与相关危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 858-864.
[12] 李琪, 黄钟莹, 袁平, 关振鹏. 基于某三级医院的ICU多重耐药菌医院感染影响因素的分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 777-782.
[13] 孟科, 李燕, 闫婧爽, 闫斌. 胶囊内镜胃通过时间的影响因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(06): 671-675.
[14] 杨艳丽, 陈昱, 赵若辰, 杜伟, 马海娟, 许珂, 张莉芸. 系统性红斑狼疮合并血流感染的危险因素及细菌学分析[J]. 中华临床医师杂志(电子版), 2023, 17(06): 694-699.
[15] 孙培培, 张二明, 时延伟, 赵春燕, 宋萍萍, 张硕, 张克, 周玉娇, 赵璨, 闫维, 吴蓉菊, 宋丽萍, 郭伟安, 马石头, 安欣华, 包曹歆, 向平超. 北京市石景山区40岁及以上居民慢性阻塞性肺疾病患病情况及相关危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(06): 711-719.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号