基于荟萃分析的腹腔镜手术治疗肝囊型包虫病的疗效评价

Clinical efficacy of laparoscopic surgery for hepatic cystic echinococcosis:a meta-analysis

目的探讨腹腔镜手术治疗肝囊型包虫病的疗效。方法在万方医学、维普、知网、PubMed、ScienceDirect、Web of Science等文献平台以"肝囊型包虫病"、"细粒棘球蚴"、"手术"、"开腹手术"、"腹腔镜"、"微创手术"、"hepatic cystic echinococcosis"、"echinococcosis","liver or hepatic","laparoscopic or minimal invasive"为关键词检索2010年2月至2020年2月文献。对纳入研究的文献中关于术中指标(如手术时间、出血量)、术后并发症、住院时间、复发率等相关数据进行提取并进行荟萃分析。结果共纳入文献9篇,其中2篇前瞻性研究,7篇回顾性病例对照研究。共纳入1031例患者,腹腔镜组272例,开腹组759例。荟萃分析结果显示,术后总并发症发生率腹腔镜组低于开腹组(OR=1.64,95%CI:1.10~2.45,P<0.05),其中切口相关并发症腹腔镜组与开腹组差异有统计学意义(OR=2.81,95%CI:1.03~7.70,P<0.05),腹腔镜组住院时间少于开腹组(SMD=1.21,95%CI:0.47~1.96,P<0.05)。腹腔镜组与开腹组患者在手术时间、术后胆漏、残腔感染及积液、术后复发率差异无统计学意义(P>0.05)。结论在严格把握腹腔镜手术适应证的前提下,行腹腔镜手术治疗肝囊型包虫病,术后并发症发生率低、住院时间短。

Objective To explore the curative effect of laparoscopic surgery for hepatic cysticercosis.Methods Search the literature from February 2010 to February 2020 on literature platforms such as Wanfang Data,VIP,CNKI,Pubmed,ScienceDirect,Web of Science,etc.the key words were"肝囊型包虫病","细粒棘球蚴","手术","开腹手术","腹腔镜","微创手术","echinococcosis","liver or hepatic","laparoscopic or minimal invasive".Data on intraoperative indicators(e.g.,operation time,bleeding volume),postoperative complications,hospital stay,recurrence rate,etc.in the literature included in the study were extracted and meta-analyzed.Results A total of 9 articles were included,including 2 prospective studies and 7 retrospective case-control studies.A total of 1031 patients were enrolled,including 272 in the laparoscopic group and 759 in the laparotomy group.The results of the meta-analysis showed that the total postoperative complication rate in the laparoscopic group was lower than that in the laparotomy group(OR=1.64,95%CI:1.10-2.45,P<0.05).Incision-related complications in the laparoscopy group and laparotomy group the difference was statistically significant(OR=2.81,95%CI:1.03-7.70,P<0.05),and the hospital stay in the laparoscopic group was shorter(SMD=1.21,95%CI:0.47-1.96,P<0.05).There was no significant difference between the two groups in operation time,postoperative bile leakage,residual cavity infection and effusion,and postoperative recurrence rate(P>0.05).Conclusions Under the premise of strictly grasping the indication of laparoscopic surgery,the incidence of complications after laparoscopic surgery is low,the hospitalization time is short.