不同气腹压下腹腔镜胆囊切除术疗效的meta分析

Different insufflation pressures for laparoscopic cholecystectomy: a meta-analysis of randomized clinical trial

目的评价腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)过程中低压气腹(low-pressure pneumoperitoneum,LP)的安全性及有效性。方法本研究从MEDLINE、EMBASE、ISI数据库、CochraneLibrary、CBM、VIP、CNKI以及万方数据库检索并纳入了在1987年1月至2009年12月间发表的LP下LC的随机对照试验,语种不限,并对纳入研究的方法学质量进行评价,最后用RevMan 5.0软件进行分析。结果共纳入7个英文随机对照试验(randomized controlled trials,RCT),包括518例患者。与传统的标准气腹压(standard pneumoperitoneum,SP)下LC相比,LP下行LC明显减少术后肩痛发生率(RR为0.50,95%CI为0.37,0.68)、缩短住院时间(WMD为-0.13,95%CI为-0.23,-0.02);手术安全性评价上,LP组和SP组间的差异无统计学意义(RR为0.84,95%CI为0.46,1.54);两组的手术时间相当(WMD为1.54,95%CI为-0.85,3.76)。结论 LP下行LC是安全有效的,更具微创优势。

Objective To determine the efficacy and safety for low-pressure pneumoperitoneum（LP） in laparoscopic cholecystectomy（LC） from randomized controlled trials（RCTs）.Methods A fully recursive literature search was conducted in Cochrane Library,MEDLINE,EMBASE,ISI databases and CBM,VIP,CNKI and Wan Fang database in any language.RCTs between Jan,1987 and Dec,2009 of LP in LC were considered for inclusion.Statistic analyses were carried out using RevMan 5.0 software.Results Five hundred and eighteen patients in 7 randomized controlled trials（RCTs） were included.The meta-analysis showed that incidence of shoulder tip pain was lower in the LP group（RR was 0.50,95% CI 0.37 to 0.68）;length of postoperative days were shorter in the LP group（WMD was-0.13,95% CI-0.23 to-0.02）;operative time and complications were similar in both groups（WMD was 1.54,95% CI-0.85 to 3.76;RR was 0.84,95% CI 0.46 to 1.54,respectively）.Conclusions LP was more effective than SP in selective LC without increasing complications.