手助腹腔镜与开腹脾切除术对巨脾患者临床疗效差异的Meta分析  

Meta-analysis of clinical efficacy of hand-assisted laparoscopic splenectomy and open splenectomy for splenomegaly

作　　者：侯松林 陈小波[2] 刘带志 李孝琼 周何[2] 李利发 张广军[2] 周彤[2] Song-lin Hou;Xiao-bo Chen;Dai-zhi Liu;Xiao-qiong Li;He Zhou;Li-fa Li;Guang-jun Zhang;Tong Zhou(Institute of Hepato-biliary-pancreas and Intestinal Diseases,North Sichuan Medical College,Nachong,Sichuan 637000,China;The Second Department of Gastrointestinal Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China)

机构地区：[1]川北医学院肝胆胰肠研究所,四川南充637000 [2]川北医学院附属医院胃肠外二科,四川南充637000

出　　处：《中国现代医学杂志》2018年第28期102-108,共7页China Journal of Modern Medicine

摘　　要：目的探讨手助腹腔镜脾切除术(HALS)与开腹脾切除术(OS)对巨脾患者临床疗效的差异。方法检索中国知网(CNKI)、中国生物医学数据库(CBM)、万方数据库、维普科技期刊(VIP)、PUBMED、COCHRANE LIBRARY等数据库,查找关于HALS和OS对巨脾患者临床疗效的临床随机对照实验或非随机对照实验文献,再用Rev Man 5.3系统评价软件进行统计学分析并阐述统计学结果。结果检索出有关文献258篇,最终纳入分析文献8篇,Meta分析结果显示HAL与OS比较,术中出血量[加权均数差(WMD)=-135.437(95%CI:-251.405,-19.469),P <0.05]、手术时间[WMD=41.097(95%CI:18.036,64.159),P <0.05]、术后肠道排气时间[WMD=0.927(95%CI:-1.401,-0.452),P <0.05]、术后住院时间[WMD=-2.557(95%CI:-3.200,-1.914),P<0.05]差异有统计学意义,而术后并发症发生率[Ol^R=0.555(95%CI:0.289,1.064),P>0.05]差异无统计学意义。结论在巨脾患者的治疗中,HALS相较于OS而言,其具有术中出血量少、术后肠道排气时间早及术后住院时间短的优势,是一种合理有效的手术方式。Objective To investigate the difference of clinical efficacy between hand-assisted laparoscopic splenectomy(HALS)and open splenectomy(OS)for the patients with splenomegaly.Methods Relevant literature was retrieved from databases including CNKI,CBM,Wanfang database,VIP,PubMed and Cochrane Library.All the relevant trials were collected for comparison of the clinical efficacy of HALS and OS on splenomegaly in the patients with randomized controlled trials(RCT)or non-RCT documents,the eligible literature and data in the literature were extracted according to a proposed standard.Then,Rev Man 5.3 software was used for statistical analysis and the statistical results were expounded.Results A total of 258 relevant papers were retrieved and 8 articles were included in the analysis.Meta-analysis results showed that the intraoperative blood loss[WMD=-135.437(95%CI:-251.405,-19.469),P<0.05],the surgery time[WMD=41.097(95%CI:18.036,64.159),P<0.05],the postoperative intestinal exhaust time[WMD=0.927(95%CI:-1.401,-0.452),P<0.05],and the postoperative hospitalization time[WMD=-2.557(95%CI:-3.200,-1.914),P<0.05]were significantly different between the HALS group and the OS group,but there was no statistically significant difference in the incidence of postoperative complications between the two groups[O^R=0.555(95%CI:0.289,1.064),P>0.05].Conclusions In the treatment of patients with splenomegaly,compared with OS,HALS has the advantages of less intraoperative blood loss,shorter postoperative intestinal exhaust time and shorter postoperative hospitalization time,so it is a reasonable and effective surgical method.

关 键 词：手助腹腔镜 巨脾 脾切除术 术后疗效 META分析 

分 类 号：R657.6[医药卫生—外科学]