肝硬化门脉高压症行LS和OS术后并发症的Meta分析

Postoperative complications of laparoscopic splenectomy versus open splenectomy for portal hypertension of liver cirrhosis:a Meta analysis

目的系统评价肝硬化门脉高压症脾功能亢进患者行腹腔镜脾切除术（LS）与开腹脾切除术（OS）术后并发症的比较。方法检索PubMed数据库、Cochrane Library、Embase数据库、CNKI及CBM数据库,查找2000~2013年发表的关于肝硬化门脉高压脾功能亢进患者行LS及OS术后并发症对比的文献资料,进行Meta分析。结果共纳入6篇文献,合计456例患者。Meta分析结果显示,LS与OS在术后出血发生率（OR=0.52,95%CI0.25~1.06,P=0.07）及术后胰瘘发生率（OR=1.09,95%CI0.33~3.60,P=0.89）上差异无统计学意义,但LS术后感染率明显低于OS（OR=0.17,95%CI 0.07~0.38,P〈0.01）,LS相较OS更易发生术后门脉系统血栓（OR=2.14,95%CI1.23~3.73,P=0.00）。结论 LS与OS在术后出血及胰瘘发生率上相同,但LS术后感染率低于OS,术后门脉系统血栓形成风险高于OS。

Objective To systematically evaluate the comparison of postoperative complications of laparoscopic splenectomy（LS）versus open splenectomy（OS）for hypersplenism secondary to portal hypertension of liver cirrhosis.Methods Clinical trials,which compared the postoperative complications of LS versus OS for portal hypertension of liver cirrhosis from the PubMed,Cochrane Library,EMbase,CNKI and CBM data bases from 2000 to 2013and the RevMan 5.2software was used for data analysis.Results six trials with 456 patients were included.Meta-analysis showed that there was no significant difference in incidences of postoperative bleeding（OR=0.52,95%CI0.25-1.06,P=0.07）or pancreatic fistual（OR=1.09,95%CI 0.33-3.60,P=0.89）between LS and OS groups.Incidence of postoperative infection was decreased in LS group compared with OS group（OR=0.17,95%CI0.07-0.38,P〈0.01）.However,the incidence of postoperative portal venous thrombosis was increased in LS group compared with OS group（OR=2.14,95%CI 1.23-3.73,P=0.00）.Conclusion LS and OS own the same incidence of postoperative bleeding and pancreatic fistual.The incidence of postoperative infection was decreased in LS group compared with OS group,meanwhile,LS group was increased compared with OS group on incidence of postoperative portal venous thrombosis.