吻合器还是夹子？：腹腔镜活体供肾肾切除术肾蒂结扎血管控制装置的系统评价和荟萃分析
Staplers or clips?: A systematic review and meta-analysis of vessel controlling devices for renal pedicle ligation in laparoscopic live donor nephrectomy.
作者信息
Liu Yu, Huang Zhongli, Chen Yuntian, Liao Banghua, Luo Deyi, Gao Xiaoshuai, Wang Kunjie, Li Hong
机构信息
Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China.
出版信息
Medicine (Baltimore). 2018 Nov;97(45):e13116. doi: 10.1097/MD.0000000000013116.
BACKGROUND
Controlling of the renal vessels is a critical step in live donor nephrectomy (LDN). Currently, mainly 2 devices, Hem-o-Lok clips and staplers, are utilized to control vessels during LDN. Both of them have advantages and disadvantages.
METHODS
This systematic review and meta-analysis was aimed to compare the safety and the efficacy of the 2 devices and to identify the better one in LDN. A systematic search for related publications in the databases of PubMed, Medline, Embase, the Cochrane Library, and Web of Science through February 2018 was performed. Eight studies were selected and evaluated with the Newcastle-Ottawa Scale (NOS).
RESULTS
The meta-analysis result showed that utilization of Hem-o-Lok clips resulted in greater amount of estimated blood loss (mean differences [MD]: 40.10; 95% confidence interval [CI] 4.37-75.84) and longer time of warm ischemia (WIT) (MD: 55.61; 95% CI 36.79-74.43) than using staplers. Residual vascular length of grafts in clip group was longer than that in stapler group (MD: 2.51; 95% CI 0.78-4.24). However, the differences in primary outcomes such as device failure rate, death rate, and severe hemorrhage rate, were not significant between these 2 groups. In addition, utilization of Hem-o-Lok clips costed approximate $400 lower than staplers per patient.
CONCLUSION
This study revealed that Hem-o-Lok clips and staplers have the similar function in LDN renal ligation, regarding the device failure rate, death rate, and severe hemorrhage rate. However, the surgeons would benefit from the clips in terms of the residue length of vessels, these outstanding features provide operation convenience and flexibility, such as right-sided donor nephrectomies, early vascular bifurcation, and rare vascular variation. In addition, the clips have potential economic advantages. In some developing countries, it would reduce the healthcare expenditure.
背景
肾血管的控制是活体供肾肾切除术（LDN）中的关键步骤。目前，LDN期间主要使用两种器械，Hem-o-Lok夹和吻合器来控制血管。两者都有优缺点。
方法
本系统评价和荟萃分析旨在比较这两种器械的安全性和有效性，并确定LDN中更好的一种。通过检索截至2018年2月的PubMed、Medline、Embase、Cochrane图书馆和Web of Science数据库中的相关出版物。选择了八项研究，并使用纽卡斯尔-渥太华量表（NOS）进行评估。
结果
荟萃分析结果显示，与使用吻合器相比，使用Hem-o-Lok夹导致估计失血量更多（平均差[MD]：40.10；95%置信区间[CI]4.37 - 75.84），热缺血时间（WIT）更长（MD：55.61；95%CI 36.79 - 74.43）。夹闭组移植物的残余血管长度比吻合器组更长（MD：2.51；95%CI 0.78 - 4.24）。然而，这两组在器械故障率、死亡率和严重出血率等主要结局方面的差异并不显著。此外，每位患者使用Hem-o-Lok夹的成本比吻合器低约400美元。
结论
本研究表明，就器械故障率、死亡率和严重出血率而言，Hem-o-Lok夹和吻合器在LDN肾结扎中具有相似的功能。然而，外科医生在血管残余长度方面会从夹子中受益，这些突出特点提供了手术便利性和灵活性，例如右侧供肾肾切除术、早期血管分叉和罕见的血管变异。此外，夹子具有潜在的经济优势。在一些发展中国家，它将降低医疗保健支出。
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