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1 569 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.
Network meta-analysis of the risk of bile leakage after laparoscopic primary choledochal closure by three duct closure methods
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,Chi-na National Knowledge Infrastructure(CNKI)and Wanfang Database were searched for rele-vant literature.Review Manager 5.4.1 and GeMTC 0.14.3 software were used for meta-analy-sis 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 1 569 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.
laparoscopic common bile duct explorationbarbed suturecontinuous suturein-terrupted suturenetwork meta-analysis