腹腔镜与开腹脾切除门奇静脉断流术防治门静脉高压症大出血近期疗效的Meta分析

A meta-analysis on the short-term outcomes between laparoscopic versus open splenectomy and azygoportal disconnection in the prevention and treatment of portal hypertension hemorrhage

目的系统评价腹腔镜脾切除门奇静脉断流术（LSD）与开腹脾切除门奇静脉断流术（OSD）防治门静脉高压症（PHT）大出血的近期疗效。方法通过Meta分析对2006年1月至2016年1月公开发表的符合纳入标准的实施LSD与OSD的随机对照研究和高质量病例对照研究论文进行系统评价。结果共纳入18篇符合标准的中英文文献，累计1359例，其中LSD为685例（腹腔镜组），OSD为674例（开腹组）。Meta分析结果显示：两组患者手术时间差异无统计学意义[MD=17．66，95％CI=（-2．46～37．78），P〉0．05]。与开腹组相比，腹腔镜组患者术后住院时间短[MD：-3．99，95％CI=（-4．82～-3．16），P〈0．05]、排气时间早[MD=-1．09，95％CI=（-1．41-0．78），P〈0．05]、术中出血量少[MD=-272．66，95％CI=（-345．11-～200．21），P〈0．05]、术后并发症率低[OR=0．34，95％CI=（0．25-0．47），P〈0．05]、术后疼痛指数低[MD=-2．54，95％CI=（-2．79--2．29），P〈0．05]、下床活动时间早[MD=-3．16，95％CI=（-3．53--2．79），P〈0．05]、术后腹腔引流量少[MD=-180．28，95％CI=（-293．06～-67．49），P〈0．05]、进食欲望时间早[MD=-1．42，95％CI=（-1．70～-1．13），P〈0．05]。结论与OSD相比，LSD创伤小，患者术后恢复快，围手术期生活质量高，可作为防治PHT大出血的优先选择术式。

Objective To systematically evaluate the short-term outcomes of laparoscopic splenectomy and azygoportal disconnection （LSD） with open splenectomy and azygoportal disconnection （OSD） in the prevention and treatment of portal hypertension （PHT） hemorrhage. Methods A recta-analysis was conducted to evaluate the short-term outcomes published in randomized controlled studies and high quality casecontrolled studies on patients who underwent LSD or OSD from January 2006 to January 2016. Results l 359 patients from 18 Chinese and English articles which met the inclusion criteria were included into this study. LSD and OSD were performed in 685 patients （the LSD group） and 674 patients （the OSD group）, respectively. Meta-analysis showed that there was no significant difference in operation time between the LSD and OSD groups [ MD = 17.66, 95% CI = （ - 2. 46 ± 37.78 ）, P 〉 0. 05 ]. When compared with the OSD group, the LSD group had a shorter postoperative hospitalization stay [MD = -3.99, 95% CI = （ -4. 82 -3. 16）, P 〈0. 05], earlier postoperatively first passing of flatus [MD = - 1.09, 95% CI = （ - 1.41 ∽- 0. 78 ）, P 〈 0. 05 ], less intraoperative bleeding [ MD = - 272. 66, 95% CI = （ - 345.11 ∽ - 200. 21 ）, P 〈 0. 05], a lower complication rate [ OR = 0. 34, 95 % CI = （ 0. 25 ∽0. 47 ）, P 〈 0. 05 ], less postoperative pain [ MD = - 2. 54, 95% CI = （ - 2. 79 ∽ - 2. 29 ）, P 〈 0. 05], shorter postoperative ambulation time [MD= -3.16, 95% CI= （ -3.53 - -2.79）, P 〈0.05], less amount of peritoneal drainage [MD = - 180. 28, 95 % CI = （ - 293.06 ∽- 67.49）, P 〈 0. 05 ] and earlier recovery from postoperative loss in appe- tite [MD= -1.42, 95%CI= （ -1.70∽ -1.13）, P〈0.05]. Conclusion Compared with the traditional OSD, LSD had the advantages of less invasiveness, quicker recovery and higher quality of life in the perioperative period. LSD is the preferred operation for the prevention and treatment of PHT massive hemorrhage.