腹腔镜与开腹阑尾切除术治疗老年急性阑尾炎患者的Meta分析

Meta analysis of laparoscopic versus open appendectomy for elderly acute appendicitis

目的用Meta分析的方法评价腹腔镜阑尾切除术与开腹阑尾切除术治疗国内老年患者急性阑尾炎的安全性和有效性。方法计算机检索清华同方中国期刊网全文数据库、维普中文科技期刊数据库、万方数据资源系统数字化期刊。检索时限均为建库至2012年10月。同时手工检索相关领域的文献。查找国内有关老年人急性阑尾炎患者应用腹腔镜阑尾切除术与开腹阑尾切除术治疗的临床对照研究。采用RevMan 5.1统计软件对各研究的围手术期死亡率、术后并发症发生和/或术前合并症加重、手术时间、术后排气时间、术后止痛药使用、术后下床活动时间、住院时间和综合治疗费用等结局指标进行综合定量评价。结果筛选后最终纳入10篇文献。总样本量共982例患者,其中腹腔镜阑尾切除术451例,开腹阑尾切除术531例。Meta分析结果显示,腹腔镜阑尾切除术组与开腹阑尾切除术组在术后并发症发生和/或术前合并症加重方面的差异有统计学意义(OR=0.15,95%CI[0.09,0.25],P<0.001);在手术时间方面的差异无统计学意义(WMD=-3.03,95%CI[-11.89,5.82],P=0.50),在术后排气时间、术后止痛药使用、术后下床活动时间、住院时间和综合治疗费用方面的差异均有统计学意义(P<0.001)。结论腹腔镜阑尾切除术治疗老年急性阑尾炎患者综合治疗费用较高,但能显著降低术后并发症和/或合并症加重的发生和缩短住院时间;将成为治疗老年急性阑尾炎患者的首选术式。

Objective To evaluate the efficiency and safety of laparoscopic （LA） and open appendectomy （OA） in the treatment of elderly acute appendicitis by using Meta analysis. Methods Chinese Journal Full text Database{CNKI）, VIP Chinese Scientific Journals Database, and Wanfang Data Resource System of Digital Periodicals were retrieved by computer and related magazines were retrieved manually. Retrieval time limits are build- ing a database to October 2012. The clinical controlled studies associated with the domestic elderly patients with acute appendicitis who treated by LA or OA were searched. The outcomes including perioperative mortality, the incidence of postoperative complications and/or heavier preoperative complications, operative time, postoperative exhaust time, postoperative pain medication use, postoperative ambulation time, length of hospital stay and treatment costs were evaluated comprehensively and quantitatively by Cochrane Collaboration RevMan 5.1 software. Results 10 clinical controlled studies were included. A total sample size involve 982 cases of patients, including 451 cases of LA groups and the OA groups 531 cases. Meta analysis showed that the difference of postoperative complications and/or heavier preoperative complications between the LA groups and OA groups was statistically significance （ OR = 0.15, 95 % CI [ 0.09,0.25 ], P 〈 0.001 ）; the difference of operative time was no statistically significance （ WMD = - 3.03,95 % CI [ - 11.89, 5.82 ], P = 0.50 ） , the differences of postoperative exhaust time, postoperative pain medication use, postoperative ambulation time, length of hospital stay and treatment costs were statistically significance（ P 〈 0.001 ）. Conclusion LA has higher treatment costs in the treatment of elderly patients with acute appendicitis , but it can significantly reduce the incidence of postoperative complications and / or heavier preoperative complications and short the length of hospital stay. LA will become the preferred surgical treatment for elderly patients with acute appendicitis.