腹腔镜与开腹阑尾切除术的系统评价

Systematic Review of Laparoscopic Versus Open Appendectomy

目的评价腹腔镜和开腹阑尾切除术的临床效果。方法按照Cochrane系统评价方法,计算机检索PubMed、Wiley Online Library、Medline、Embase、Cochrane图书馆及中国生物医学文献数据库(CBM)、中国学术期刊网全文数据库(VIP)、中文科技期刊全文数据库(CNKI),检索时间截至2011年11月,并手工检索相关文献,查找比较腹腔镜和开腹阑尾切除术的随机对照文献。由2位研究者按照纳入和排除标准筛选文献,评价质量并提取资料后采用RevMan 4.2.2进行Meta分析。分析两种手术方法的伤口感染、住院时间、手术时间、住院费用及腹腔脓肿发生率。结果纳入8篇随机对照试验,Meta分析结果显示,腹腔镜和开腹阑尾切除术的伤口感染〔OR=0.19,95%CI(0.09,0.38),P<0.000 01〕、手术时间〔WMD=3.66,95%CI(0.50,6.82),P=0.02〕及住院费用〔WMD=503.96,95%CI(337.23,670.70),P<0.000 01〕比较,差异均有统计学意义;二者的住院时间〔WMD=-0.11,95%CI(-3.64,3.43),P=0.95〕及腹腔脓肿发生率〔OR=1.40,95%CI(0.23,8.64),P=0.71〕比较,差异无统计学意义。结论腹腔镜阑尾切除手术较开腹阑尾切除术伤口感染率低,但手术时间长,费用高;二者住院时间和腹腔脓肿发生率差异无统计学意义。

Objective To evaluate the clinical effectiveness of laparoscopic and open appendectomy.Methods Literatures relating to randomized controlled trials in English and Chinese on the comparison of clinical effectiveness after laparoscopic and open appendectomy in appendicitis from PubMed,Wiley Online Library,Medline,Embase,Cochrane,CNKI,VIP,CBM databases were extracted,and methodological quality was evaluated by two reviewers independently with designed extraction form.The Cochrane Collaboration’s RevMan 4.2.2 software was used for data analysis.The wound infection,hospitalization time,operation time,hospitalization expenses,and peritoneal abscess were compared between laparoscopic and open appendectomy.Results Eight published reports of eligible studies were extracted.Compared with the open appendectomy,laparoscopic appendectomy had significant differences in lower wound infection rate〔OR=0.19,95%CI（0.09,0.38）,P0.000 01〕,longer operation time〔WMD=3.66,95%CI（0.50,6.82）,P=0.02〕,and more hospitalization expenses〔WMD=503.96,95%CI（337.23,670.70）,P0.000 01〕.But there were no significant differences in hospitalization time〔WMD=-0.11,95%CI（-3.64,3.43）,P=0.95〕and incidence rate of peritoneal abscess〔OR=1.40,95%CI（0.23,8.64）,P=0.71〕between laparoscopic and open appendectomy.Conclusions The wound infection rate is lower,but the operation time is longer,the hospitalization expenses is more in laparoscopic appendectomy as compared with open appendectomy.There are no statistically significant differences of hospitalization time and incidence rate of abdominal abscess between laparoscopic and open appendectomy.