重型阑尾炎术后非腹腔引流与腹腔引流的系统评价

A systematic review of non-peritoneal drain and peritoneal drain after the postoperative of severe appendicitis

目的评价重型阑尾炎术后非腹腔引流的临床疗效和安全性。方法计算机检索中国期刊全文数据库(1994～2008.10),中国生物医学文献数据库(1978～2008.10),中文科技期刊全文数据库(1989～2008.10),数字化期刊全文数据库(1997～2008.10),MEDLINE(1966～2008.10),EMBASE(1974～2008.10),Cochrane Library(2008年第3期)和SCI(1974～2008.10),并辅手工检索和其他检索。按照纳入排除和标准,由两名研究者独立筛选并提取资料,采用Jadad评分标准评价纳入研究的方法学质量,采用RevMan5.0软件进行统计学处理。结果最终纳入15个研究,包括2809例患者。Meta分析结果显示,非腹腔引流与腹腔引流在切口感染率[OR=0.43,95%CI(0.29,0.65)]、肠粘连发生率[OR=0.26,95%CI(0.18,0.37)]和住院时间[WMD=-0.38,95%CI(-4.96,-1.20)]方面有统计学差异,而脓肿发生率[OR=0.77,95%CI(0.39,1.51)]没有统计学差异。结论当前研究显示,与腹腔引流相比,非腹腔引流能显著减少重型阑尾炎患者的切口感染率和肠粘连发生率,减少住院天数。由于纳入研究样本量小且质量较低,上述结论尚需要高质量、大样本的随机双盲对照试验加以证实。

Objective To assess the efficency and safety of non-peritoneal drain versus peritoneal drain after appendectomy of severe appendicitis. Methods Randomized controlled trials （RCTs） or quasi-randomize controlled trials（QRCTs ） were searched and identified from CNKI （1994 to Oct 2008）, CBM （ 1978 to Oct 2008）, VIP （ 1989 to Oct 2008）, Wanfang Data （ 1997 to Oct 2008 ）, MEDLINE （ 1966 to Oct 2008）, EMBASE （1974 to Oct 2008）,The Cochrane Library （issue3, 2008） and SCI （1974 to Oct 2008）, and related journals were also scanned. We evaluated the quality of the included studies by Jadad scale and analyzed the data by Cochrane Collaboration＇ s RevMan 5. 0. Results We included 15 randomized controlled trials or quais-randomized controlled trials （n = 2809）. Meta analysis showed that there were statisticly differences between two groups on the incidence of wound infection [OR = 0. 43,95 % CI （0.29,0.65）], postoperative intestinal adhesion [OR = 0. 26,95%CI（0.18,0. 37）1 and the duration of hospital stay [WMD= - 0.38,95%CI（ - 4.96, - 1.20）], but no difference was found on the incidence of abscesses[OR = 0. 77,95%CI（0.39,1. 51）1. Conclusions The current evidences show that contrast with peritoneal drain, the non-peritoneal drain can significantly reduce the incidence of wound infection and intestinal adhesion, and shorten the duration of hosipital stay. Before draw the conclution into clinical practice, further high-quality,large scale,double-blind randomized controlled trials are still needed.