选择性脾动脉栓塞术与传统开腹手术治疗外伤性脾破裂安全性和有效性的Meta分析  

Safety and efficacy of partial splenic artery embolization versus conventional open surgery for traumatic splenic rupture:A Meta-analysis

作　　者：张孔玺 李小红 李越洲 商中华[1] Zhang Kongxi;Li Xiaohong;Li Yuezhou;Shang Zhonghua(Department of General Surgery,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院普通外科,太原030001

出　　处：《中华普通外科学文献（电子版）》2022年第6期452-460,共9页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的比较选择性脾动脉栓塞术(PSAE)与传统开腹手术(OS)治疗外伤性脾破裂的临床疗效。方法检索中国知网、万方数据、维普数据库、PubMed、Web of Science、Embase数据库中关于PSAE和OS两种手术方式治疗外伤性脾破裂的相关文献,检索时间为建库至2022年5月31日。提取文献内数据,采用RevMan 5.3软件进行Meta分析。结果最终纳入16篇文献共5238例患者,其中PSAE组1037例,OS组4201例。Meta分析显示:相较于OS组,PSAE组术中出血量更少(WMD=-392.95,95%CI:-667.52,-118.38;P=0.005),术中输血量更少(WMD=-433.87,95%CI:-582.85,-284.89;P<0.00001),手术时间更短(WMD=-60.25,95%CI:-71.99,-48.52;P<0.00001),抢救成功率更高(WMD=4.00,95%CI:1.32,12.09;P=0.01),且PSAE组术后下床时间(WMD=-14.44,95%CI:-20.32,-8.55;P<0.00001)和住院时间(WMD=-4.89,95%CI:-5.86,-3.91;P<0.00001)更短;术后并发症发生率方面,PSAE组术后切口感染(OR=0.21,95%CI:0.11,0.37;P<0.00001)、肠梗阻(OR=0.24,95%CI:0.10,0.55;P=0.0008)、肺炎(OR=0.44,95%CI:0.32,0.61;P<0.00001)的发生率均低于OS组,但两组术后脾脓肿、发热、腹腔积液的比较,差异无统计学意义;术后免疫功能恢复方面,PSAE组术后1个月的CD3^(+)水平(WMD=9.27,95%CI:6.32,12.22;P<0.00001)、CD4^(+)水平(WMD=5.60,95%CI:3.86,7.34;P<0.00001)、CD4^(+)/CD8^(+)值(WMD=0.35,95%CI:0.18,0.52;P<0.00001)均高于OS组,但OS组术后1个月的CD8^(+)水平高于PSAE组(WMD=-1.20,95%CI:-1.72,-0.68;P<0.00001)。结论在外伤性脾破裂患者的诊治中,PSAE较OS有其独到优势,具有操作简单、手术时间短、术中出血量少、术后并发症少、住院时间短、术后免疫功能恢复早等优势,值得临床选用。Objective To compare the clinical efficacy of partial splenic artery embolization(PSAE)with conventional open surgery(OS)in the treatment of traumatic splenic rupture.Methods The literatures related to two surgical modalities,PSAE and OS,in the treatment of traumatic splenic rupture were retrieved in CNKI,Wanfang data,VIP,PubMed,Web of Science and Embase databases from the date of database establish to May 31,2022.Data within the literatures were extracted and analyzed using RevMan 5.3 software.Results A total of 5238 patients within 16 literatures were finally included,including 1037 in the PSAE group and 4201 in the OS group.Meta analysis results showed that compared to OS group,PSAE group had less intraoperative bleeding(WMD=-392.95,95%CI:-667.52,-118.38;P=0.005),less intraoperative blood transfusion(WMD=-433.87,95%CI:-582.85,-284.89;P<0.00001),shorter operative time(WMD=-60.25,95%CI:-71.99,-48.52;P<0.00001),higher salvage success rate(WMD=4.00,95%CI:1.32,12.09;P=0.01),and PSAE group had shorter postoperative bed-off time(WMD=-14.44,95%CI:-20.32,-8.55;P<0.00001)and length of stay(WMD=-4.89,95%CI:-5.86,-3.91;P<0.00001)than OS group,with statistically significant differences.In terms of postoperative complication,the incidence of postoperative incisional infection(OR=0.21,95%CI:0.11,0.37;P<0.00001),postoperative intestinal obstruction(OR=0.24,95%CI:0.10,0.55;P=0.0008),and postoperative pneumonia(OR=0.44,95%CI:0.32,0.61;P<0.00001)in PSAE group were lower than that in OS group;however,the differences were not statistically significant when comparing postoperative splenic abscess,fever,and peritoneal effusion.Regarding the recovery of postoperative immune function,levels of CD3^(+)(WMD=9.27,95%CI:6.32,12.22;P<0.00001),CD4^(+)(WMD=5.60,95%CI:3.86,7.34;P<0.00001),and CD4^(+)/CD8^(+)values(WMD=0.35,95%CI:0.18,0.52;P<0.00001)at one month postoperatively in PSAE group were higher than those in OS group,but the level of CD8^(+)at one month postoperatively was higher in OS group than that in PSAE group(WMD=-1.20,95%CI:-1.

关 键 词：外伤性脾破裂 选择性脾动脉栓塞术 开腹脾切除术 脾修补术 临床疗效 META分析 

分 类 号：R657.62[医药卫生—外科学]