单孔腹腔镜与传统三孔腹腔镜阑尾切除术安全性及有效性的Meta分析

Effectiveness and safety of single-incision vs conventional three-port laparoscopic appendectomy: A meta-analysis

目的:系统评价单孔腹腔镜与传统三孔腹腔镜阑尾切除术的安全性及有效性.方法:计算机检索The Cochrane Library(2014年第5期)、EMbase、PubMed、中国期刊全文数据库、中国科技期刊全文数据库、中国生物医学文献数据库、维普数据库及万方数据库等中外生物医学数据库,补充检索Google Scholar等搜索引擎,纳入单孔腹腔镜与传统三孔腹腔镜阑尾切除术的随机对照试验(randomized controlled trials,RCTs),检索日期截止至2014-06.按Cochrane系统评价方法筛选文献、提取数据并评价方法学质量,采用RevMan 5.2软件进行Meta分析.结果:共纳入12个RCTs,包含1577例患者,Meta分析结果显示:相比传统三孔腹腔镜,单孔腹腔镜阑尾切除术患者具有更高的术后美容评分(SMD=0.52,95%CI:0.21-0.83,P=0.001),但手术时间较长(MD=7.10,95%CI:4.31-9.89,P<0.00001).患者术后疼痛程度、术后并发症、术后腹腔脓肿发生率及留院时间无显著性差异.结论:单孔腹腔镜阑尾切除术应用于阑尾良性疾病是安全有效的,较传统三孔腹腔镜阑尾切除术存在一定优势,值得临床参考.

AIM： To evaluate the safety and clinical effectiveness of single-incision laparoscopic appendectomy（SILA）.METHODS： We electronically searched The Cochrane Library（Issue 5, 2014）, EMbase, PubMed, China Academic Journal, Chinese Science and Technology Journal Full-text data-base, Chinese Biomedical Literature Database, VIP and Wanfang Data until June 1, 2014. Randomized controlled trials（RCTs） describing SILA and conventional three-port laparoscopic appendectomy（CTLA） were included. The quality of included studies was assessed and analyzed using RevMan 5 software（version 5.2）.RESULTS： A total of 12 RCTs involving 1577 patients were included. Meta-analysis indicated that compared with CTLA, there were significant differences in cosmetic result score（SMD = 0.52, 95%CI： 0.21-0.83, P = 0.001） and operative time（MD = 7.10, 95%CI： 4.31-9.89, P〈0.00001） in the SILA group. However, no differences were found in postoperative pain score（VAS）, postoperative complications, postoperative abdominal abscess and hospital stay between the two groups. CONCLUSION： SILA is a safe and effective technique for the treatment of uncomplicated benign appendix disease, and it has certain advantages over the CTLA.