腹腔镜与开腹手术治疗成人急性阑尾炎的Meta分析

Laparoscopic Versus Open Appendectomy for Adult Acute Appendicitis:Meta-analysis

目的用Meta分析的方法评价腹腔镜阑尾切除术(LA)与开腹阑尾切除术(OA)治疗成人急性阑尾炎的有效性和安全性。方法计算机检索Cochrane Library、PubMed、EMBase、中国生物医学文献数据库、维普中文科技期刊数据库、中国期刊全文数据库,手工检索相关领域的杂志,同时从纳入文献的参考文献中查找符合要求的随机对照试验。中文检索词包括"阑尾炎、阑尾切除术、腹腔镜、开腹手术、开放手术",英文检索词包括"appendecto-my,laparoscopic,LA,open"。测量指标包括手术时间、切口感染、住院时间、腹腔脓肿。用RevMan 5.0软件进行统计分析。结果共纳入17篇随机对照试验,Meta分析结果显示:LA与OA治疗成人急性阑尾炎在切口感染发生率〔风险比(RR)=0.40,95%CI(0.27,0.59)〕、手术时间〔加权均数差(MD)=13.95,95%CI(7.00,20.89)〕、住院时间〔MD=-0.47,95%CI(-0.66,-0.29)〕方面差异有统计学意义;而在腹腔脓肿发生率方面差异无统计学意义〔RR=1.02,95%CI(0.64,1.65)〕。结论 LA治疗成人急性阑尾炎所需的手术时间长,但切口感染发生率少,住院时间短,故LA安全、有效,值得在临床中广泛推广。

Objective To evaluate the efficiency and safety of laparoscopic （LA） and open appendectomy （OA） in the treatment of adult acute appendicitis by using Meta analysis. Methods Cochrane Library, PubMed, EMBase, Chinese Biomedical Literature Database, VIP Chinese Scientific Journals Database, and Chinese Journal Full - text Database were re- trieved by computer and related magazines were retrieved manually. Meanwhile, random - controlled trials were searched among the involved bibliographies. The Chinese search terms were： appendicitis, appendectomy, laparoscopic, open appendectomy and open surgery. The English search terms were： appendectomy, laparoscopic, LA and open. The measurement indicators were operation time, wound infection, hospital stay and intraabdominal abscesses. Statistical analysis was performed by using RevMan 5.0 software. Results 17 random - controlled trials were included, Meta analysis demonstrated that the LA and OA, when treating adult acute appendicitis, showed statistically significant differences in the incidence of wound infection [ RR = 0.40, 95%CI （0.27, 0.59）], operation time [MD=13.95, 95%CI （7.00, 20.89）3 and hospitalstay （MD=-0.47, 95% CI （ -0. 66, -0. 29 ）]. While they showed no statistically significant difference in intraabdominal abscesses [ RR = 1.02, 95% CI （0. 64, 1.65 ） 3. Conclusion LA has longer operation time in the treatment of adult acute appendicitis but with lower incidence of wound infection and shorter hospital stay. LA is safe and effective and should be recommended in clinic.