Vaska Ashish I, Abbas Saleh
Department of Surgery, University Hospital Geelong, PO Box 281, 3220, Australia.
Department of Surgery, University Hospital Geelong, PO Box 281, 3220, Australia; School of Medicine, Deakin University Geelong, Locked Bag 20000, 3220, Australia.
HPB (Oxford). 2019 Feb;21(2):148-156. doi: 10.1016/j.hpb.2018.07.008. Epub 2018 Sep 21.
Bile leak following liver resection can be associated with significant morbidity. This systematic review and meta-analysis aims to evaluate the effect of intraoperative bile leak testing on postoperative bile leak rate and other complications after liver resection without biliary reconstruction for any cause.
PubMed, MEDLINE, Embase, Cochrane Library and grey literature databases were searched for articles between 1960 and 2017 comparing bile leak rates with or without bile leak testing. Standard meta-analysis methods were used. The primary outcome was bile leak rate, and secondary outcomes were overall morbidity, reintervention rate and length of stay.
8 articles met inclusion criteria. Intraoperative bile leak testing after resection was associated with lower postoperative bile leak rate (4.1% vs 12.3%, OR 0.36, 95% CI 0.23-0.55, p < 0.001), overall morbidity (OR 0.67, 95% CI 0.47-0.96, p = 0.030), need for reintervention (OR 0.11, 95% CI 0.03-0.36, p < 0.001) and a shorter duration of hospital stay (2.21 days, 95% CI 0.69-3.73, p = 0.004).
The routine use of intraoperative bile leak testing during liver resection results in a significant reduction in postoperative bile leak rate, overall morbidity, length of hospital stay and need for re-intervention. Bile leak testing should be performed after liver resection without biliary reconstruction.
肝切除术后胆漏可能会导致严重的发病率。本系统评价和荟萃分析旨在评估术中胆漏检测对因任何原因未进行胆道重建的肝切除术后胆漏率及其他并发症的影响。
检索了PubMed、MEDLINE、Embase、Cochrane图书馆和灰色文献数据库中1960年至2017年间比较有无胆漏检测时胆漏率的文章。采用标准的荟萃分析方法。主要结局是胆漏率，次要结局是总体发病率、再次干预率和住院时间。
8篇文章符合纳入标准。切除术后进行术中胆漏检测与术后较低的胆漏率（4.1%对12.3%，OR 0.36，95%CI 0.23 - 0.55，p < 0.001）、总体发病率（OR 0.67，95%CI 0.47 - 0.96，p = 0.030）、再次干预需求（OR 0.11，95%CI 0.03 - 0.36，p < 0.001）以及较短的住院时间（2.21天，95%CI 0.69 - 3.73，p = 0.004）相关。
肝切除术中常规使用术中胆漏检测可显著降低术后胆漏率、总体发病率、住院时间和再次干预需求。对于未进行胆道重建的肝切除术后应进行胆漏检测。
