腹腔镜与剖腹急诊结肠切除术治疗穿孔性结肠憩室炎疗效对比的Meta分析

Comparative effectiveness of laparoscopic versus open emergency colectomy for perforated colonic diverticulitis:a meta-analysis

目的:应用Meta分析的方法,对比腹腔镜与传统剖腹结肠切除术治疗穿孔性结肠憩室炎的近期效果。方法:检索PubMed、Embase、Cochrane Library、中国知网与万方数据库已公开发表的有关腹腔镜与剖腹结肠切除术治疗穿孔性结肠憩室炎近期效果对比研究的临床文献。采用R软件与RevMan 5.3软件对符合条件的结果进行Meta分析。结果:共纳入7篇文献、11540例患者,其中腹腔镜组2449例,剖腹组9091例。腹腔镜组术后并发症发生率、术后死亡率、术后住院时间低于剖腹组,手术时间长于剖腹组。腹腔镜组中转开腹率为33%。两组非计划再手术率差异无统计学意义。结论:腹腔镜结肠切除术治疗穿孔性结肠憩室炎的手术效果并不劣于剖腹手术。由经验丰富的外科医师施术,可能取得较剖腹手术更好的效果。

Objective:To compare the short-term efficacy of laparoscopy with laparotomy emergency colectomy for perforated colonic diverticulitis by meta-analysis.Methods:PubMed,Embase,Cochrane Library,CNKI and Wanfang databases were searched for published clinical literatures on comparative studies of the short-term results of laparoscopic and open colectomy for perforated colonic diverticulitis.Meta-analysis was performed for all eligible results using R software and RevMan 5.3 statistical software.Results:Seven literatures consisting of 11540 patients were included;2449 patients received laparoscopic colectomy and 9091 patients received open colectomy.As compared to the laparotomy group,laparoscopy group was associated with a significantly lower postoperative complication,mortality and shorter postoperative hospital stay.But laparoscopy group had significantly longer operative time compared with laparotomy group.The conversion rate of emergent laparoscopy was 33%in pooled data.In term of unscheduled reoperation,there were no significant differences between the two groups.Conclusions:Laparoscopic colectomy for perforated colonic diverticulitis is not inferior to laparotomy.If laparoscopic surgery is performed by a skilled surgeon,better results than laparotomy may be achieved.