腹腔镜与开腹手术治疗结肠镜诊疗所致肠穿孔临床疗效的Meta分析

A meta-analysis of laparoscopic versus open surgery for colonoscopic perforation

目的以Meta分析评估腹腔镜手术(LS)和开腹手术(OS)在结肠镜诊疗所致肠穿孔治疗中的有效性和安全性。方法在PubMed、EMBASE、Web of Science和Cochrane Library中检索腹腔镜和开腹手术治疗结肠镜诊断所致肠穿孔的临床试验,采用改良MINORS量表对文献质量进行评价,分析年龄、性别比例、结肠镜检查目的、腹部手术史、手术类型、穿孔大小、手术时间、住院时间、术后并发症发生率、术后死亡率。连续变量采用加权平均差(WMD),二分变量采用优势比(OR)进行Meta分析。结果共纳入7项非随机对照试验,合计172例患者(LS组97例,OS组75例)进行Meta分析。两组年龄、性别比例、结肠镜检查目的、腹部手术史、穿孔大小、手术时间和死亡率等方面比较差异均无统计学意义(均P > 0.05)。LS组住院时间较短,术后并发症发生率较低,差异有统计学意义(均P < 0.05)。结论 LS是一种治疗结肠镜诊疗所致肠穿孔的安全有效的技术,与OS相比术后住院时间短,术后并发症少,恢复更快。

Objectives To perform a meta-analysis of comparing effectiveness and safety of laparoscopic (LS) and open surgery (OS) in treating colonoscopic perforation. Methods Clinical trials of LS and OS in treating colonoscopic perforation were re trieved from PubMed, EMBASE, Web of Science, and Cochrane Library. Study quality was evaluated using methodological index for non-randomized studies. The followings were analyzed: age, sex, purpose of colonoscopy, history of abdominal surgery, types of surgery, size of perforation, duration of surgery, duration of hospitalization, incidence of postoperative complications, and postop erative mortality. Meta-analysis was performed by weighted mean difference for continuous variables and odds ratio for dichoto mous variables. Results Seven non-randomized controlled trials of 172 patients (97 LS and 75 OS) were included. There was no significant between-group difference in age, sex, purpose of colonoscopy, history of abdominal surgery, size of perforation, dura tion of surgery, and postoperative mortality (P > 0.05). LS group had significantly shorter duration of hospitalization and lower in cidence of postoperative complications compared with OS groups (P < 0.05). Conclusion Compared with OS, LS is a safe and effective approach for treating colonoscopic perforation. It is associated with shorter duration of hospitalization, fewer complica tions and faster recovery.