腹腔镜与开腹复杂性阑尾炎手术治疗比较的Meta分析  

Meta-analysis of laparoscopic versus open appendectomy for complicated appendicitis

作　　者：赵海远 张义胜[1] 王明海[1] 赵军[1] 徐冉[1] 

机构地区：[1]皖南医学院附属弋矶山医院,安徽芜湖241000

出　　处：《腹腔镜外科杂志》2015年第7期550-555,共6页Journal of Laparoscopic Surgery

摘　　要：目的：应用循证医学分析与评价腹腔镜手术治疗复杂性阑尾炎的优势及有效性。方法：通过文献检索并收集2007～2014年公开发表的有关腹腔镜与开腹复杂性阑尾炎手术的文献,包括中文与外文文献。使用Review Manager 5.2统计软件进行Meta分析。结果：最终筛选出符合此分析设计标准的研究文献共9篇,样本总量1 222例,包含腹腔镜组680例,开腹组542例。分类统计分析两组术中情况、术后患者恢复情况及术后并发症等。与开腹组相比,腹腔镜组术中出血量更少[WMD=2.12,95%CI：（0.84,3.40）,P〈0.05],术后排气更快[WMD=3.35,95%CI：（1.53,5.17）,P〈0.05]、住院时间更短[WMD=1.37,95%CI：（0.31,2.43）,P〈0.05]、术后切口感染率[RR=5.29,95%CI：（3.27～8.57）,P〈0.05]及术后肠梗阻发生率[RR=2.72,95%CI：（1.44～5.11）,P〈0.05]更低。两组患者手术时间[WMD=-0.20,95%CI：（-0.73,0.34）,P〉0.05]、腹腔脓肿发生率[RR=1.46,95%CI：（0.86～2.48）,P〉0.05]差异无统计学意义（P〉0.05）。结论：腹腔镜手术治疗复杂性阑尾炎具有术中出血量少、术后康复快、切口感染与术后肠梗阻发生率低的优势,是安全、有效、可行的。Objective：To assess the advantages and effectiveness of laparoscopic appendectomy （LA） versus open appendecto- my （OA） for complicated appendicitis through evidence-based medicine. Methods ：The literature retrieval containing both Chinese and foreign versions was conducted on articles published from 2007 to 2014 for comparison between LA and OA for complicated appendici- tis. Meta-analysis was conducted by RevMan 5.2 software. Results： According with analysis and design standards, nine studies were se- lected from the large number of samples. The total number was 1 222,including laparoseopie surgery （ n = 680） and open surgery （ n = 542）. The intraoperative situations, the patients＇ recovery after operation as well as postoperative complications of laparoscopie surgery and open surgery group were statistically analyzed. Compared with open surgery, LA resulted in less blood loss volume [ WMD = 2.12, 95 % CI ： （0.84：, 3.40）, P 〈 0.05 ], hastened first flatus [ WMD = 3.35,95 % CI ： （ 1.53,5.17 ）, P 〈 0.05 ] and shortened postoperative hospital stay [ WMD = 1.37195% CI ： （0.31,2.43 ）, P 〈 0.05 ], lessened the rates of wound infection [ RR = 5.29,95% CI ： （ 3.27 -8.57 ）, P 〈 0.05 ] and postoperative intestinal obstruction [ RR = 2.72,95 % CI ： （ 1.44-5.11 ）, P 〈 0.05 ]. There were no significant differences in the rate of abdominal abscess [ RR = 1.46,95% CI ： （0.86-2.48）, P 〉 0.05 ] and the operating time [ WMD = -0.20, 95% CI：（-0.73,0.34） ,P 〉0.05 ] between the two groups, Conclusions： LA for complicated appendicitis is associated with improved outcomes in terms of less blood loss, quicker recovery, and lower rates of wound infection and postoperative intestinal obstruction. There- fore, LA is safe, effective and feasible for complicated appendicitis.

关 键 词：复杂性阑尾炎 腹腔镜检查 剖腹术 META分析 

分 类 号：R656.8[医药卫生—外科学]