腹腔镜与开放手术治疗胆总管囊肿临床效果的Meta分析

Laparoscopic versus open surgery for choledochal cyst: a Meta-analysis

目的:通过Meta分析的方法比较腹腔镜与开腹手术治疗先天性胆总管囊肿的有效性和安全性。方法:检索国内外数据库中有关腹腔镜与开腹手术治疗小儿胆总管囊肿效果的回顾性分析或病例对照研究,再根据制定的标准筛选文献行Meta分析。结果:最终纳入10篇文献,共1 394例患者,其中589例行腹腔镜手术(腹腔镜组),805例行开腹手术(开腹组)。与开腹组比较,腹腔镜组手术时间延长(WMD=54.51,95%CI=24.37~84.64,P<0.05);术中失血量减少(WMD=-16.27,95%CI=-21.16^-11.39,P<0.05);术后首次排气时间、进食时间缩短(WMD=-1.2,95%CI=-1.22^-1.18;WMD=-1.31,95%CI=-1.62^-1.00,均P<0.05);术后住院时间与并发症发生率减少(WMD=-3.04,95%CI=-4.08^-2.36;OR=0.37,95%CI=0.15~0.90,均P<0.05)。结论:腹腔镜手术相对于开腹手术治疗胆总管囊肿具有明显的优势;随着腹腔镜技术与术者水平的不断提高,腹腔镜手术将成为治疗胆总管囊肿首选术式。

Objective： To compare the safety and efficacy between laparoscopic and open surgery in treatment of choledochal cyst by using Meta-analysis. Methods： The retrospective or case-control studies comparing laparoscopic versus open surgery for choledochal cyst in children were searched from the national and international databases. Meta-analysis was performed after literature screening according to the inclusion criteria. Results： Ten studies were finally included, involving a total of i 394 patients, of whom, 589 cases underwent laparoscopic surgery （laparoscopic group） and 805 cases underwent open surgery （open surgery group）. In laparoscopic group compared with open surgery group, the operative time was prolonged （WMD=54.51,95% CI=24.37-84.64, P〈0.05）, while the intraoperative blood loss was reduced （WMD=-16.27, 95% CI= -21.16--11.39, P〈0.05）, time to first postoperative flatus and food intake was shortened （WMD=-1.2, 95% CI= -1.22--1.18; WMD=-1.31, 95% CI=-1.62--1.00, both P〈0.05）, and length of postoperative hospital stay and incidence of postoperative complications were decreased （WMD=-3.04, 95% CI=-4.08--2.36; OR=0.37, 95% CI=0.15-0.90, both P〈0.05）. Conclusion： Laparoscopic surgery has shown superiority in treatment of choledochal cyst compared with open surgery. With the improvement of laparoscopic techniques and deftness of surgeon＇s practice, laparoscopic surgery may become the first choice procedure for choledochal cyst.