腹腔镜与开腹手术治疗溃疡性结肠炎的安全性和有效性对照研究的系统评价

Safety and feasibility of iaparoscopic surgery and open surgery in ulcerative colitis： a Metaanalysis

目的比较溃疡性结肠炎（UC）腹腔镜手术与开腹手术的安全性和有效性。方法外文数据库检索词：Ulcerative Colitis OR Inflammatory Bowel Disease AND Laparoscopy AND Open Surgery OR Open Procedure。中文数据库检索词：炎症性肠病OR溃疡性结肠炎AND腹腔镜AND开腹手术。检索1992年1月至2008年5月发表的相关英文或中文全文文献,检索出符合入选标准的对照研究16项共计923例患者．采用固定效应模型和随机效应模型对UC腹腔镜手术与开腹手术的安全性和有效性指标进行Meta分析。结果与开腹手术相比，UC的腹腔镜手术明显缩短了开始进食时间（P〈0．01）和术后住院天数（P〈0．01），减少了术后总并发症发生率（P〈0．01），但延长了手术时间（P〈0．05）。在肠功能恢复时间、再次手术率、腹腔脓肿、吻合口瘘、肠梗阻、切口感染、术中出血量和死亡率方面未见明显优势。中转开腹手术率为4．2％。结论溃疡性结肠炎腹腔镜手术是安全、可行的，且术后短期恢复较快。

Objective To compare the safety and feasibility of laparoscopic surgery and open surgery in ulcerative colitis. Methods A search of published studies in English and Chinese between January 1992 and May 2008 was performed. Nine hundred and twenty-three patients from 16 studies were recruited which met the inclusion criteria. Meta-analysis was performed through fixed effect model or random effect model dependent on heterogeneity. Results Compared to open procedure, patients with ulcerative colitis undergone laparoscopic surgery were able to tolerate oral intake significantly earlier （P〈0.01） with shorter hospital stay （P〈0.01） and had lower total complication rate （P〈0.01）. But duration of laparoseopic surgery was significantly longer than that of open procedure （P=0.04）. Laparoseopie procedure was no more superior to open procedure in recovery of bowel function, re-operation rate, intra-abdominal abscess, anastomotic leak, postoperative bowel obstruction, wound infection, blood loss and mortality. The conversion rate was 4.2% in this analysis. Conclusion Laparoscopic surgery for ulcerative colitis is safe and feasible with better recovery in short-term as compared to the open procedure.