Abstract
Objective To compare the biliary complications after biliary reconstruction with or without transcystic biliary drainage (TBD) in liver transplantation (LT). Methods A meta-analysis was performed on eligible literature in PubMed, EMbase, sinoMed, web of Science, the Cochrane Central Register of Controlled Trials, Wanfang Datebase, CNKI, VIP Datebase, and other databases from their establishment to Feb. 28, 2017, to screen the clinical controlled trials about transcystic biliary drainage (TBD), T-tube drainage (T-T) and primary closure in the biliary reconstruction of LT. The major endpoints were overall biliary complications, bile leaks, biliary stricture, and tube removal related bile leak. After study selection, data extraction and quality assessment were conducted by two independent reviewers. Meta-analysis was performed by using the RevMan 5.3.0 soft-ware. Results A systematic review and meta-analysis of 6 case-control cohort studies (3 trials with TBD or T-T;1 trial with C-tube or primary closure; 2 trials with TBD, T-T, and primary closure) was performed to compare the biliary complications after biliary tract reconstruction with or without TBD in LT. 542 patients were included in the meta-analysis consisting of 347 in the TBD group, 102 in the T-tube group, and 133 in the primary clo-sure group. The data analysis showed that the biliary tract reconstruction with TBD was significantly superior to T-T according to the incidence of biliary stricture and bile leak after removal (14.3％ vs 30.2％, RR=3.37, 95％CI=0.33～0.75, P=0.0008; 1.7％ vs 18.8％, RR=2.48, 95％CI=0.05～0.70, P=0.01); However, their overall biliary complications and bile leak were similar (7.3％ vs 10.8％, RR=1.27, 95％CI=0.50～1.16, P=0.21; 23.9％ vs 30.4％, RR=1.03, 95％CI=0.30～1.45, P=0.30). Meanwhile, the biliary tract reconstruction with TBD showed bet-ter but statistically insignificant outcomes than that with primary closure according to the incidence of overall bil-iary complications and biliary stricture (25.8％ vs 39.2％, RR=0.29, 95％CI=0.58～1.50, P=0.77; 14.0％ vs 19.2％, RR=0.61, 95％CI=0.54～3.24, P=0.54); In addition, they showed equivalent outcomes for bile leak (17.4％ vs 15.8％, RR=0.47, 95％CI=0.47～1.59, P=0.64). Conclusion TBD was equivalent to primary closure and superior to T-tube in the prevention of the biliary complication. Hence, the usage of TBD in biliary tract reconstruction is feasible and useful for LT surgery.关键词
肝移植/经胆囊管胆道引流/T管引流/胆道并发症/Meta分析Key words
liver transplantation/transcystic biliary drainage/T-tube/biliary complication/Meta-analysis分类
医药卫生
