国内腹腔镜与开腹修补术在良性胃穿孔患者中应用的Meta分析

The application of laparoscopic versus open repair in patients with benign gastric perforation: a domestic meta-analysis

目的:探讨腹腔镜修补术治疗良性胃穿孔的可行性和安全性。方法:对国内已公开发表的有关腹腔镜与开腹修补术在良性胃穿孔中应用的文献进行Meta分析,数据采用标准化均数差(SMD)、优势比(OR)和95%置信区间(95%CI)表达。结果:纳入文献17篇,共1 457例患者,其中腹腔镜修补术组(观察组)730例,开腹修补术组(对照组)727例。分析表明:相比开腹修补术,腹腔镜修补术不仅可减少手术时间和术中出血量(P<0.05),缩短术后肠鸣音恢复时间、肛门首次排气时间和住院时间(P<0.05),降低术后切口感染、肠梗阻、盆腹腔感染等并发症的发生率(P<0.05);且术后血清胃泌素的分泌水平更高(P<0.05)。结论:相比开腹修补术,腹腔镜胃穿孔修补术具有减少手术时间、住院时间、术中出血量和术后并发症,缩短术后肠鸣音恢复时间、肛门首次排气时间,术后血清胃泌素分泌水平更高等优势,因而安全可行。

Objective：To investigate the feasibility and security of laparoscopic repair in the treatment of benign gastric perforation. Methods：The primary literature about laparoscopic and open repair in the treatment of benign gastric perforation were retrieved and filtered,and then a recta-analysis was carried out based on the data. Data were assessed by standardized mean difference（SMD） , odds ratio（OR） and 95% confidence interval（ 95% CI）. Results：Seventeen articles involving 1 459 patients with benign gastric perforation,lncluding laparoscopic repair group（ observation group）of 730 cases ,727 cases in the open repair（ control group） ,were incorporated. From the pooled analyses,compared to open repair, laparoscopic repair can not only reduce operative time and blood loss （P 〈 0. 05 ） , shorten recovery time after bowel sounds, first anal exhaust time and length of hospital stay （ P 〈 0.05 ） , reduce postoperative incision infection,intestinal obstruction, abdominal infections and so on （P 〈 0.05 ） ;but also improve the level of postoperative serum gastrin secretion （ P 〈 0.05 ）. Concluslon： Compared with open repair, laparoscopic gastric perforation repair can reduce operative time, hospital stay, blood loss and postoperative complications, shorten recovery time after bowel sounds and first anal exhaust time,improve serum advantages of gastrin secretion;therefore it is safe and feasible.