Picchio Marcello, Lucarelli Pierino, Di Filippo Annalisa, De Angelis Francesco, Stipa Francesco, Spaziani Erasmo
Department of Surgery, Hospital "P. Colombo," Velletri, Italy.
Basildon Hospital, Basildon, England.
JSLS. 2014 Oct-Dec;18(4). doi: 10.4293/JSLS.2014.00242.
Routine drainage after laparoscopic cholecystectomy is still controversial. This meta-analysis was performed to assess the role of drains in reducing complications in laparoscopic cholecystectomy.
An electronic search of Medline, Science Citation Index Expanded, Scopus, and the Cochrane Library database from January 1990 to June 2013 was performed to identify randomized clinical trials that compare prophylactic drainage with no drainage in laparoscopic cholecystectomy. The odds ratio for qualitative variables and standardized mean difference for continuous variables were calculated.
Twelve randomized controlled trials were included in the meta-analysis, involving 1939 patients randomized to a drain (960) versus no drain (979). The morbidity rate was lower in the no drain group (odds ratio, 1.97; 95% confidence interval, 1.26 to 3.10; P = .003). The wound infection rate was lower in the no drain group (odds ratio, 2.35; 95% confidence interval, 1.22 to 4.51; P = .01). Abdominal pain 24 hours after surgery was less severe in the no drain group (standardized mean difference, 2.30; 95% confidence interval, 1.27 to 3.34; P < .0001). No significant difference was present with respect to the presence and quantity of subhepatic fluid collection, shoulder tip pain, parenteral ketorolac consumption, nausea, vomiting, and hospital stay.
This study was unable to prove that drains were useful in reducing complications in laparoscopic cholecystectomy.
腹腔镜胆囊切除术后的常规引流仍存在争议。本荟萃分析旨在评估引流在降低腹腔镜胆囊切除术后并发症方面的作用。
对1990年1月至2013年6月的医学文献数据库、科学引文索引扩展版、Scopus和Cochrane图书馆数据库进行电子检索，以确定比较腹腔镜胆囊切除术中预防性引流与不引流的随机临床试验。计算定性变量的比值比和连续变量的标准化均数差。
荟萃分析纳入了12项随机对照试验，涉及1939例患者，随机分为引流组（960例）和不引流组（979例）。不引流组的发病率较低（比值比，1.97；95%置信区间，1.26至3.10；P = .003）。不引流组的伤口感染率较低（比值比，2.35；95%置信区间，1.22至4.51；P = .01）。术后24小时不引流组的腹痛较轻（标准化均数差，2.30；95%置信区间，1.27至3.34；P < .0001）。在肝下积液的存在和量、肩部尖端疼痛、静脉注射酮咯酸的用量、恶心、呕吐和住院时间方面无显著差异。
本研究未能证明引流对降低腹腔镜胆囊切除术后并发症有用。
