van Dijk Aafke H, van Roessel Stijn, de Reuver Philip R, Boerma Djamila, Boermeester Marja A, Donkervoort Sandra C
Departement of Surgery, Amsterdam University Medical Centre, Amsterdam 1105 AZ, The Netherlands.
Department of Surgery, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands.
World J Gastrointest Surg. 2018 Sep 27;10(6):57-69. doi: 10.4240/wjgs.v10.i6.57.
To study the effect of different techniques of cystic duct closure on bile leakage after laparoscopic cholecystectomy (LC) for biliary disease.
A systematic search of MEDLINE, Cochrane and EMBASE was performed. Rate of cystic duct leakage (CDL) was the primary outcome. Risk of bias was evaluated. Odds ratios were analyzed for comparison of techniques and pooled event rates for non-comparative analyses. Pooled event rates were compared for each of included techniques.
Out of 1491 articles, 38 studies were included. A total of 47491 patients were included, of which 38683 (81.5%) underwent cystic duct closure with non-locking (metal) clips. All studies were of low-moderate methodological quality. Only two studies reported separate data on uncomplicated and complicated gallbladder disease. For overall CDL, an odds ratio of 0.4 (95%CI: 0.06-2.48) was found for harmonic energy clip closure and an odds ratio of 0.17 (95%CI: 0.03-0.93) for locking non-locking clips. Pooled CDL rate was around 1% for harmonic energy and metal clips, and 0% for locking clips and ligatures.
Based on available evidence it is not possible to either recommend or discourage any of the techniques for cystic duct closure during LC with respects to CDL, although data point out a slight preference for locking clips and ligatures other techniques. No separate recommendation can be made for complicated gallbladder disease.
研究不同胆囊管闭合技术对胆道疾病行腹腔镜胆囊切除术（LC）后胆漏的影响。
对MEDLINE、Cochrane和EMBASE进行系统检索。胆囊管漏出率（CDL）为主要结局指标。评估偏倚风险。分析比值比以比较技术，并分析合并事件率以进行非比较性分析。对纳入的每种技术的合并事件率进行比较。
在1491篇文章中，纳入了38项研究。共纳入47491例患者，其中38683例（81.5%）采用非锁定（金属）夹闭合胆囊管。所有研究的方法学质量为低到中等。只有两项研究报告了单纯性和复杂性胆囊疾病的单独数据。对于总体CDL，谐波能量夹闭合的比值比为0.4（95%CI：0.06 - 2.48），锁定夹与非锁定夹闭合的比值比为0.17（95%CI：0.03 - 0.93）。谐波能量和金属夹的合并CDL率约为1%，锁定夹和结扎的合并CDL率为0%。
基于现有证据，就CDL而言，无法推荐或不推荐LC期间任何一种胆囊管闭合技术，尽管数据表明对锁定夹和结扎术相对于其他技术略有偏好。对于复杂性胆囊疾病无法给出单独的推荐。
