妊娠期急性阑尾炎腹腔镜手术与开腹手术疗效与安全性的Meta分析  

Efficacy and safety of laparoscopic and open appendectomy for acute appendicitis in pregnancy:a Meta-analysis

作　　者：丁丽萍 徐翔 谢杨[1] 汲广岩[1] 张宏宇[1] 王子卫[1] DING Liping;XU Xiang;XIE Yang;JI Guangyan;ZHANG Hongyu;WANG Ziwei(Department of Gastrointestinal Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of General Surgery,Chongqing Ninth People′s Hospital,Chongqing 400700,China)

机构地区：[1]重庆医科大学附属第一医院胃肠外科,400016 [2]重庆市第九人民医院普通外科,400700

出　　处：《重庆医学》2020年第11期1831-1840,共10页Chongqing medicine

摘　　要：目的分析腹腔镜(LA)手术和开腹(OA)手术应用在急性阑尾炎孕妇中的疗效和安全性。方法检索2005年1月至2019年3月公开发表的比较LA手术和OA手术治疗妊娠期急性阑尾炎的疗效与安全性的临床研究,检索数据库包括Medline(Pubmed)、Cochrane Library、Embase、中国知网、万方等国内外大型综合数据库。文献筛选/纳入研究的质量评价及数据提取均由两名作者独立进行,非随机研究的方法学指标(MINORS)量表进行质量评价,采用RevMan5.3软件进行Meta分析。结果22篇文献中共有6640例孕妇纳入Meta分析,其中LA组2126例,OA组4514例。Meta分析结果显示,与OA组相比,LA组具有更短的手术时间(MD=-8.09,95%CI:-12.00^-4.18,P<0.001)、住院时间(MD=-2.33,95%CI:-3.09^-1.58,P<0.001)及术后排气时间(MD=-1.69,95%CI:-1.98^-1.41,P<0.001),更少的术中出血量(MD=-20.51,95%CI:-26.40^-14.63,P<0.001),更低的术后并发症发生率(OR=0.26,95%CI:0.16~0.43,P<0.001),更低的早产率(OR=0.45,95%CI:0.33~0.63,P<0.001),更高的流产率(OR=1.81,95%CI:1.30~2.52,P<0.001)。而两组患者在妊娠不良事件(包括流产及早产)、剖宫产率、胎儿的出生体质量等结局指标上比较,差异无统计学意义(P>0.05)。结论LA组手术结局明显优于OA组,且具有更低的早产率,但流产率高于OA组。Objective To analyze the efficacy and safety of laparoscopic(LA)and open approach(OA)in pregnant women with acute appendicitis.Methods Studies published from Jan.2005 to Mar.2019 that compared the efficacy and safety of LA and OA for pregnant women with acute appendicitis were searched in Medline(Pubmed),Cochrane Library,Embase,CNKI and Wanfang database.The literature screening/quality assessment and data extraction were performed by two investigators independently.The quality was evaluated using Methodological Index for Non-Randomized Studies(MINORS).Lastly,the Meta analysis was performed using RevMan5.3 software.Results A total of 6640 pregnant women from 22 studies were included in the Meta-analysis,with 2126 in the LA group and 4514 in the OA group.Meta-analysis suggested that the LA group had shorter operative time(MD=-8.09,95%CI:-12.00,-4.18,P<0.001),hospital stays(MD=-2.33,95%CI:-3.09,-1.58,P<0.001)and postoperative exhaust time(MD=-1.69,95%CI:-1.98,-1.41,P<0.001),and less amount of intraoperative bleeding(MD=-20.51,95%CI:-26.40,-14.63,P<0.001),lower postoperative complication rate(OR=0.26,95%CI=0.16,0.43,P<0.001),premature delivery rate(OR=0.45,95%CI=0.33,0.63,P<0.001),and higher abortion rate(OR=1.81,95%CI=1.30,2.52,P<0.001).No statistically significant differences were found in adverse pregnancy events(including abortion and premature delivery),rate of caesarean section,birth weight.Conclusion The outcomes of the LA group were significantly better than that of the OA group,and the premature delivery rate was lower,but the abortion rate was higher than that of the OA group.

关 键 词：阑尾炎 阑尾切除术 妊娠期 腹腔镜 开腹 流产 

分 类 号：R615[医药卫生—外科学]