腹腔镜手术与开腹手术治疗克罗恩病疗效的Meta分析

Laparoscopic versus open surgery for Crohn's disease: a Meta-analysis

目的：比较腹腔镜手术与开腹手术在治疗克罗恩病（CD）围手术期并发症发生率与长期疗效。方法：检索中英文数据库,收集相关的非随机对照研究,根据Cochrane Reviewers手册5.0筛选文献、提取资料、评价文献质量,使用RevMan 5.2软件进行Meta分析。结果：最终纳入23篇非随机对照研究,共2 101例患者,其中1 006例行腹腔镜手术（腹腔镜组）,1 095例行开腹手术（开腹组）。Meta分析结果显示,腹腔镜组低围手术期总并发症明显低于开腹组（RR=0.74,95%CI=0.6-0.91,P=0.004）;长期随访中,腹腔镜组术后切口疝的发生率明显降低（RR=0.21,95%CI=0.07-0.68,P=0.009）,但术后疾病的复发率及肠梗阻发生率的差异无统计学意义（均P〉0.05）。结论：腹腔镜手术治疗CD病在降低围手术期总并发症与术后切口疝的发生率方面优于开腹手术。

Objective： To compare the incidence ofperioperative complications and long-term efficacy between laparoscopic and open surgery in treatment of Crohn＇s disease （CD）. Methods： The relevant non-randomized controlled trials （nRCTs） were collected by searching several Chinese and English online databases. The studies were screened, data were extracted, and the quality was evaluated according to the Cochrane Reyiewers Handbook 5.0, and then Meta-analysis was made by using RevMan 5.2 software. Results： Twenty-three nRCTs were finally included involving 2 101 patients, of whom, 1 006 cases underwent laparoscopic surgery （laparoscopic surgery group） and 1 095 underwent open surgery （open surgery group）. Results of Meta-analysis showed that the incidence of perioperative complications was significantly decreased in laparoscopic surgery group compared with open surgery group （RR=0.74, 95% CI=0.6-0.91, P=0.004）; in long-term follow-up, the incidence of postoperative incisional hernia in laparoscopic surgery group was significantly lower than that in open surgery group （RR=0.21, 95% CI=0.07-0.68, 19=0.009）, while the disease recurrence rate and incidence of bowel obstruction had no statistical difference between the two groups （both P〉0.05）. Conclusion- For CD, laparoscopic surgery is superior to open surgery in reducing perioperative complications and postoperative incisional hernia.