背景:有多种预防肾移植(KTx)后淋巴囊肿形成的方法。然而,高达1/3的患者仍有淋巴结肿大,这些不同方法预防淋巴结肿大的有效性没有得到很好的描述。这里,我们总结了目前预防KTx术后淋巴囊肿的策略。
方法:我们在多个文献数据库中进行了搜索,包括Medline(通过PubMed),WebofScience,EMBASE,和CochraneCentral.KTx后的淋巴囊肿形成是感兴趣的结果。随机效应模型被用来评估合并估计,以危险比(HR)和比值比(OR)表示,连同随机合并估计(ES),95%置信区间(95%CI),P值。我们用以下预防方法计算了KTx后淋巴囊肿形成的合并率:LigaSure,止血材料,预防性引流,结扎,腹膜开窗术,和双极烧灼技术。
结果:在排除重复项之后,文献检索检索到87项独特的研究。20篇报告5445例患者的论文被纳入定性分析。LigaSure方法的合并淋巴囊肿率为3.0%(95%CI=0.6-13.7),排水8.3%(95%CI=6.4-10.7),止血材料为9.2%(95%CI=5.9-14.1),结扎12.2%(95%CI=9.2-16.1),腹膜开窗术占14.4%(95%CI=12.0-17.3),双极密封为20.5%(95%CI=10.2-36.8)。
结论:尽管采取了预防措施,KTx术后淋巴囊肿的发生率仍然很高.使用LigaSure似乎是预防淋巴囊肿的最有效方法。然而,考虑到广泛的淋巴结肿大发生率和缺乏对照组,有必要进一步验证这些发现.
BACKGROUND: There are multiple methods for preventing
lymphocele formation after kidney transplantation (KTx). However, lymphoceles still develop in up to one third of patients and the effectiveness of these different methods in preventing lymphocele is not well described. Here, we summarize the current strategies for preventing
lymphocele after KTx.
METHODS: We conducted searches across several literature databases, including Medline (via PubMed), Web of Science, EMBASE, and Cochrane Central.
Lymphocele formation after KTx was the outcome of interest. A random-effects model was applied to evaluate pooled estimates, which were presented as hazard ratios (HRs) and odds ratios (ORs), along with the random pooled estimate (ES), 95% confidence interval (95% CI), and P value. We calculated the pooled rate of
lymphocele formation after KTx with the following preventive methods: LigaSure, haemostatic materials, prophylactic drainage, ligation, peritoneal fenestration, and bipolar cautery techniques.
RESULTS: The literature search retrieved 87 unique studies after excluding duplicates. Twenty papers reporting on 5445 patients were incorporated in the qualitative analysis. The pooled lymphocele rate was 3.0% (95% CI = 0.6-13.7) for the LigaSure method, 8.3% (95% CI = 6.4-10.7) for drainage, 9.2% (95% CI = 5.9-14.1) for haemostatic materials, 12.2% (95% CI = 9.2-16.1) for ligation, 14.4% (95% CI = 12.0-17.3) for peritoneal fenestration, and 20.5% (95% CI = 10.2-36.8) for bipolar sealing.
CONCLUSIONS: Despite preventive methods, the incidence of lymphocele following KTx remains high. The use of LigaSure appears to be the most effective method for preventing
lymphocele. However, given the broad range of reported lymphocele rates and lack of control groups, further validation of these findings is necessary.