Department of Pediatric Surgery, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia.
J Pediatr Surg. 2013 Nov;48(11):2336-42. doi: 10.1016/j.jpedsurg.2013.07.020.
Excision has been established as a standard management practice for choledochal cysts in the last few decades. The two most commonly performed methods of reconstruction after excision are hepaticoduodenostomy (HD) and Roux-en-Y hepaticojejunostomy (HJ), of which the HJ is favored by most surgeons. Evidence concerning the optimal method of reconstruction is, however, sparse.
Studies comparing outcomes from HD and HJ after choledochal cyst excision were identified by searching Medline, Ovid, Search Medica, Elsevier Clinicalkey, Google Scholar and Cochrane library. Suitable studies were chosen and data extracted for meta-analysis. Outcomes evaluated included operative time, hospital stay and incidence of postoperative bile leak, cholangitis, reflux/gastritis, anastomotic stricture, bleeding, intestinal obstruction and re-operative rate. Pooled odds ratios (OR) were calculated for dichotomous variables; pooled mean differences (MD) were measured for continuous variables.
Six retrospective studies were included in this meta-analysis, comprising a total of 679 patients, 412 of whom (60.7%) underwent HD, and the remainder, 267 (39.3%) underwent HJ. Although, HD group had slightly shorter hospital stay (MD: 0.30; 95% CI: -0.22-0.39; P < 0.00001) it showed a higher incidence of postoperative reflux/gastritis (OR: 0.08; 95% CI: -0.02-0.39; P = 0.002). However, the other outcomes such as bile leak, cholangitis, anastomotic stricture, bleeding, operative time, reoperation rate and adhesive intestinal obstruction did not differ between HD and HJ groups.
HD shows higher postoperative reflux/gastritis than HJ but a shorter hospital stay. There are few good-quality studies that compare the outcomes from HD and HJ, meaning that caution should be exercised in the generalization of the results of this meta-analysis, which suggests HD to be comparable with HJ in terms of other complications, operative benefits and outcomes.
在过去几十年中，切除已被确立为治疗胆总管囊肿的标准治疗方法。切除后重建最常用的两种方法是肝肠吻合术（HD）和 Roux-en-Y 胆管空肠吻合术（HJ），其中大多数外科医生更喜欢 HJ。然而，关于最佳重建方法的证据仍然很少。
通过搜索 Medline、Ovid、Search Medica、Elsevier Clinicalkey、Google Scholar 和 Cochrane 图书馆，确定了比较 HD 和 HJ 术后胆总管囊肿切除术后结果的研究。选择合适的研究并提取数据进行荟萃分析。评估的结果包括手术时间、住院时间以及术后胆漏、胆管炎、反流/胃炎、吻合口狭窄、出血、肠梗阻和再次手术率的发生率。对二项变量计算合并优势比（OR）；对连续变量测量合并均数差（MD）。
本荟萃分析纳入了 6 项回顾性研究，共纳入 679 例患者，其中 412 例（60.7%）接受了 HD，其余 267 例（39.3%）接受了 HJ。尽管 HD 组的住院时间略短（MD：0.30；95%CI：-0.22-0.39；P<0.00001），但术后反流/胃炎的发生率较高（OR：0.08；95%CI：-0.02-0.39；P=0.002）。然而，HD 和 HJ 组在其他结果（如胆漏、胆管炎、吻合口狭窄、出血、手术时间、再次手术率和粘连性肠梗阻）方面没有差异。
HD 术后反流/胃炎发生率高于 HJ，但住院时间较短。比较 HD 和 HJ 结果的高质量研究很少，因此在推广本荟萃分析结果时应谨慎，该分析结果表明，HD 在其他并发症、手术获益和结果方面与 HJ 相当。
