手助腹腔镜与开腹手术治疗门脉高压症的Meta分析

Comparison of Hand-assisted Laparoscopic Surgery and Open Surgery for Portal Hypertension:A Meta-analysis

目的比较手助腹腔镜手术(HALS)与开腹手术(OS)在门脉高压症治疗中的临床价值。方法计算机检索PubMed、EMBASE、Cochrane Library和中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库、数字化期刊全文数据库,同时从参考文献中进行追溯查找。收集国内外所有相关的随机对照试验或高质量的病例对照研究,根据Cochrane系统评价手册5.1质量评价标准进行质量评价,使用RevMan 5.1软件进行Meta分析。结果共纳入8个研究(435例患者)。Meta分析结果显示:与OS行脾切除加断流术治疗门脉高压相比,HALS组的手术时间有短于开腹组的趋势,但差异无统计学意义[MD=-7.44,95%CI=(-36.00~21.12),P=0.61];术中出血量[MD=-140.95,95%CI=(-233.58^-48.32),P=0.003]、术后引流量[MD=-544.32,95%CI=(-789.97^-298.67),P<0.0001]、术后排气时间[MD=-28.30,95%CI=(-41.90^-14.69),P<0.0001]、术后住院时间[MD=-3.61,95%CI=(-4.16^-3.07),P<0.00001]、术后并发症发生率[OR=0.35,95%CI=(0.15~0.82),P=0.02]差异均有统计学意义,且HALS组好于OS组。结论与传统开腹手术相比,HALS能降低手术出血量并缩短术后排气时间和住院时间,手术创伤较小,术后并发症较少,患者恢复较快,具有较好的临床应用前景。

Objective To evaluate the clinical efficacy and safety of hand-assisted laparoscopic surgery （HALS） vs. open surgery （OS） for portal hypertension. Methods Relevant literature was retrieved from data- bases including PubMed, EMBASE, Cochrane Library, Chinese Biomedical Literature Database, Chinese Jour- nal Full Text Database, Chinese Vip Datebase, and Chinese Wanfang. All the relevant trials were collected and then we performed the literature screening. The quality of the included trials was assessed by Cochrane Systematic Review Handbook 5.1. Meta-analyses were conducted by RevMan 5.1 software. Results Eight studies were in- volved and 435 patients were included. Meta-analysis showed that there was significant difference in intraoperative blood loss[ MD = - 140. 95, 95% CI = （ - 233.58- - 48.32）, P = 0. 003 ], total abdominal drainage volume [MD= -544.32, 95% CI= （-789.97--298.67）, P 〈0.0001], postoperative exhaust time [ MD= -28.30, 95% CI= （ -41.90-- 14. 69）, P 〈0.0001], length of postoperative hospital stay [MD = -3.61, 95% CI= （ -4. 16--3.07）, P〈0.00001], postoperative complication [0R=0.35, 95% CI= （0. 15-0.82）,P = 0. 02 ] between HALS group and OS group. However, the operative time was not significantly different be- tween these two groups [ MD = -7. 44, 95% CI = （ -36. 00-21.12）, P = 0. 61 ]. Conclusions Compared with the traditional OS, HALS can reduce intraoperative bleeding, postoperative exhaust time, hospitalization time, surgical trauma, and postoperative complications. The HALS. However, its long-term effictiveness and safety still trials. patients often recover more quickly from the needs to be further verified by randomized controlled trials.