Antoniou S, Koch O, Antoniou G, Köhler G, Chalkiadakis G, Pointner R, Granderath F
Center for Minimally Invasive Surgery Neuwerk Hospital, Mönchengladbach, Germany -
Minerva Chir. 2014 Jun;69(3):185-94.
Routine drainage of the subhepatic space has been a surgical trend of open cholecystectomy, carried on to the era of laparoscopic surgery without substantial evidence. Avoiding the potentially devastating sequelae of an undetected bile leakage is the main rationale behind this practice. Aim of this meta-analysis was to compare evidence on routine drain placement after laparoscopic cholecystectomy versus no drainage. A meta-analysis of randomized controlled trials was conducted; outcome variables included postoperative pain, subhepatic collection, 30-day morbidity, wound-related complications, and drainage interventions. The fixed- and random effects models were used in order to calculate combined overall effect sizes of pooled data. Data are presented as the odds ratio (OR) or difference in means with 95% confidence interval (CI). Six randomized trials including 1167 patients were identified. Pain scores were significantly higher in the drainage group both at 6-12h (mean difference 1.12, 95% CI 1.01-1.24, P<0.0001) and at 12-24h after surgery (mean difference 1.12, 95% CI 0.86-1.39, P<0.0001). No difference was found with regard to the incidence of subhepatic collection and drainage procedures. A trend in favor of the no drain approach with regard to 30-day morbidity and wound infection was registered, although this was less pronounced after sensitivity analysis. The possible clinical benefit of routine use of abdominal drainage in uncomplicated laparoscopic cholecystectomies requires larger study populations. The approach is however not encouraged on the basis of the present analysis, as it results in increased postoperative pain and overall morbidity.
肝下间隙的常规引流一直是开腹胆囊切除术的手术趋势，这种做法延续到了腹腔镜手术时代，但却缺乏充分的证据。避免未被发现的胆漏所带来的潜在灾难性后果是这种做法背后的主要理由。本荟萃分析的目的是比较腹腔镜胆囊切除术后常规放置引流管与不放置引流管的证据。我们进行了一项随机对照试验的荟萃分析；结果变量包括术后疼痛、肝下积液、30天发病率、伤口相关并发症和引流干预措施。为了计算汇总数据的综合总体效应大小，我们使用了固定效应模型和随机效应模型。数据以比值比（OR）或均值差异及95%置信区间（CI）的形式呈现。我们确定了6项随机试验，共纳入1167例患者。引流组在术后6 - 12小时（均值差异1.12，95% CI 1.01 - 1.24，P < 0.0001）和12 - 24小时（均值差异1.12，95% CI 0.86 - 1.39，P < 0.0001）的疼痛评分均显著更高。在肝下积液和引流操作的发生率方面未发现差异。在30天发病率和伤口感染方面，有倾向于不放置引流管方法的趋势，尽管在敏感性分析后这种趋势不太明显。在无并发症的腹腔镜胆囊切除术中常规使用腹腔引流的可能临床益处需要更大的研究人群。然而，基于目前的分析，这种方法不被鼓励，因为它会导致术后疼痛增加和总体发病率上升。
