我国手助腹腔镜与开腹脾切除术临床疗效比较的系统评价

Laparoscopic-assisted versus open splenectomy: a systematic review of domestic studies

目的:用系统评价的方法比较手助腹腔镜脾切除术与开腹脾切除术的临床效果。方法:收集1991年—2012年国内公开发表的有关比较手助腹腔镜脾切除术与开腹脾切除术的临床对照研究,筛选出符合条件的研究进行Meta分析。结果:经筛选后纳入符合标准的文献8篇,共419例患者,其中手助腹腔镜脾切除202例(手助组),开腹脾切除217例(开腹组)。Meta分析结果显示手助组的手术时间较开腹组长,而术中出血量、胃肠功能恢复时间、住院时间均小于开腹组(均P<0.05)。结论:手助腹腔镜脾切除术具有术中出血量少、术后胃肠功能恢复快、住院时间短等优点。然而因该系统评价纳入研究多为非随机对照试验,研究中存在偏倚因素并可能会对最终结论造成影响,因此上述结论尚需谨慎对待,仍需进一步开展多中心、大样本随机对照试验来验证。

Objective： To compare the clinical effects between hand-assisted laparoscopic splenectomy and open splenectomy by means of systematical review. Methods： The domestically published literature of studies （1991 to 2012） regarding hand-assisted laparoscopic splenectomy versus open splenectomy was collected, and the studies that met the inclusion criterion were reviewed by Meta-analysis. Results： Eight studies were finally included after screen, with a total of 419 patients, of whom, 202 cases received hand-assisted laparoscopic splenectomy （hand-assisted group） and 217 cases underwent open splenectomy （open surgery group）. The results of Meta-analysis showed that the operative time was prolonged, but the intraoperative blood loss, time to gastrointestinal function recovery and length of hospital stay were all reduced in hand-assisted group compared with open surgery group （all P〈0.05）. Conclusion： Hand-assisted laparoscopic splenectomy has the advantages of less bleeding, fast gastrointestinal function recovery and short hospital stay. However, this conclusion should be considered cautiously, due to the risk of bias created by many non-randomized studies included in this review. So it remains to be confirmed by further multi-center, large sample size and randomized controlled trials.