腹腔镜与开腹手术治疗先天性十二指肠梗阻疗效比较的Meta分析  

Laparoscopy versus open surgery for congenital duodenal obstruction:Meta-analysis of comparative studies

作　　者：谷一超 黄金狮 华凯云 赵勇 廖俊敏 Gu Yichao;Huang Jinshi;Hua Kaiyun;Zhao Yong;Liao Junmin(Department of Neonatal Surgery,Beijing Children's Hospital,Capital Medical University,National Children's Medical Center,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院新生儿外科,北京100045

出　　处：《中华小儿外科杂志》2022年第1期6-13,共8页Chinese Journal of Pediatric Surgery

摘　　要：目的通过Meta分析系统比较腹腔镜手术(laparoscopic surgery,LS)与传统开腹手术(open surgery,OS)治疗先天性十二指肠梗阻的临床疗效。方法检索万方数据库、中国知网、维普数据库、PubMed、Web of Science数据库、Cochrane图书馆,收集近10年国内外LS与OS治疗先天性十二指肠梗阻的随机或非随机对照研究。分析指标包括:手术时间、术后呼吸机使用时间、术后开始进食时间,达到全量喂养时间,住院时间及并发症。应用RevMan 5.3软件进行统计学分析。结果共纳入9项研究,487例患儿,其中LS组226例,OS组261例。Meta分析结果显示LS组手术时间长于OS组,差异具有统计学意义[MD=42.45,95%CI=(20.02,64.88)]。而两组间的术后呼吸机使用时间[MD=-0.84,95%CI=(-2.61,0.92)]、术后开始进食时间[MD=-0.56,95%CI=(-2.14,1.03)]、术后达到全量喂养时间[MD=-2.43,95%CI=(-5.46,0.60)]、住院时间[MD=-0.38,95%CI=(-3.40,4.17)],差异无统计学意义。LS组的吻合口相关并发症及与吻合口无关的并发症发生率均低于OS组(1.8%比3.1%,11.9%比16.7%)。结论现有证据表明,与OS相比,运用LS治疗先天性十二指肠梗阻可达到同等的治疗效果,尽管手术时间长,但并发症发生率低。Objective To review the currently available data and evaluate a meta-analysis of the efficacy and safety of laparoscopic surgery(LS)versus open surgery(OS)for congenital duodenal obstruction(CDO)through Meta-analysis.Methods Wanfang data,China National Knowledge Infrastructure(CNKI),VIP,PubMed,Web of Science and Cochrane Library were searched for randomized versus non-randomized controlled comparative studies of LS versus OS for CDO over the last decade.The relevant parameters included operative duration,ventilator usage,time to initial enteral feeding,time to full enteral feeding,length of hospital stay and complications.Meta-analysis was performed with RevMan 5.3 software.Results Nine studies of examining the effectiveness of LS(n=226)versus OS(n=261)were included.Operative duration was longer in LS group than that in OS group[MD=42.45,95%CI=(20.02,64.88)].No significant inter-group difference existed in ventilator usage[MD=-0.84,95%CI=(-2.61,0.92)],time to initial enteral feeding[MD=-0.56,95%CI=(-2.14,1.03)],time to full enteral feeding[MD=-2.43,95%CI=(-5.46,0.60)]and length of hospital stay[MD=-0.38,95%CI=(-3.40,4.17)].The overall incidence of anastomotic and nonanastomotic-related complications was less in LS group than those in OS group(1.8%vs 3.1%,11.9%vs 16.7%).Conclusions OS/LS for CDO can achieve the similar therapeutic effect.Despite a longer operative duration,the incidence of complications remains low.

关 键 词：腹腔镜 先天性十二指肠梗阻 荟萃分析 

分 类 号：R726.5[医药卫生—儿科]