腹腔镜手术与开腹手术治疗慢传输型便秘临床效果的Meta分析

Laparoscopic surgery versus open surgery for slow transit constipation：a meta-analysis of clinical outcomes

目的系统评价腹腔镜手术以及开腹手术治疗慢传输型便秘的临床效果。方法全面检索PubMed、corchranelibrary、EMBASEdatabase、OVIDLWWdatabase、ACPJournalClub、康健临床决策循证数据库（ForeignEvidence．BasedMedicine，FEBM）、中国医学文献数据库（CBM）、万方数据库、维普数据库以及中国知网数据库。检索时限均为建库至2012年7月。收集腹腔镜手术与开腹手术治疗慢传输型便秘的比较研究的英文文献以及中文文献，通过至少两名研究者的独立筛选获得最终的纳入研究文献，利用RevMan5．1软件对两种方法的治疗效果进行Meta分析。结果最终纳入8篇，其中5篇随机对照研究，2篇回顾性研究，1篇临床对照研究。与开腹手术相比，腹腔镜手术术后粘连性肠梗阻发生率（RR=0．20，95％CI：0．06～0．67，P=0．009）以及术后切口并发症发生率（RR=0．21，95％CI：0．07～0．63，P=0．005）降低，术中出血量（WMD=-95．96，95％CI：-134．02～-57．90，P〈0．00001）减少，住院时间（d）（WMD=-4．02，95％CI：-6．33～-1．72，P=0．0006）以及术后肠道功能恢复时间（d）（WMD=-1．19，95％CI：-2．09—0．29，P=0．010）缩短。但手术时间（WMD=24．42，95％CI：3．21～-45．63，P=0．02）增加。两种方法的术后进食流质时间以及排便次数的差异无统计学意义。结论腹腔镜手术治疗慢传输型便秘能够达到开腹手术的安全性和疗效，同时能够显著降低开腹手术的手术并发症。

Objective To evaluate the clinical outcomes of laparoscopic surgery versus open sur- gery for slow transit constipation. Methods A complete literature search was performed using PubMed, Cochrane Library, EMBASE, OVID LWW, ACP Journal Club, Foreign Evidence-Based Medicine, CBM, Wanfang,VIP and CNKI database from inception to July 2012 for all English/Chinese studies comparing laparoscopic surgery and open surgery for treatment of slow transit constipation. Data were screened and e- valuated by at least two reviewers independently. The meta-analysis was carried out by RevManS. 1 soft- ware on the different outcomes of the two groups. Results A total of 8 studies were included into the anal- ysis. Five were randomized controlled trials, two were retrospective analysis and one was clinical controlled trail. Compared with the open surgery group,laparoscopic surgery group had a lower incidence of postopera- tive adhesive ileus （ RR = 0.20,95% CI ： 0.06 ~ 0.67, P = O. 009 ） and incisional complications （ RR = 0.21,95% CI ： 0.07 - 0.63, P = O. 005 ） , less blood loss during operation （ WMD = - 95.96,95% CI ： - 134.02 - - 57.90,P 〈 0. 00001 ）, shorter hospital stay （ WMD = - 4.02,95 % CI ： - 6.33 - - 1.72, P = 0.0006 ） and postoperative recovery time of bowel function （ WMD = - 1.19,95 % CI ： - 2.09 ~ 0.29, P = 0. 010）. But the laparoscopic surgery group had a longer operative time（ WMD = 24.42,95% CI： 3.21 - -45.63 ,P = 0.02 ）compared with the open surgery group. There were no statistically significant differences between the two groups in first fluid - feeding time and recovery time of intestine function. Condusion Laparoscopic surgery is as feasible and safe as open surgery and can significantly reduce surgical complications of open surgery for slow transit constipation.