ERAT与LA治疗粪石崁顿型阑尾炎疗效对比的meta分析

Efficacy comparison of ERAT versus LA for treating fecalith incarceration appendicitis:a meta-analysis

目的采用系统评价的方式比较内镜逆行性阑尾治疗术(ERAT)与腹腔镜阑尾切除术(LA)对粪石崁顿型阑尾炎的疗效。方法计算机检索PubMed、Cochrane Library、Embase、中国知网、万方数据库,检索时间为2016-2021年。收集EART相关的临床试验,对符合纳入标准的文献进行Jadad评分,分别提取各研究的基本情况及各项观察指标[腹痛缓解、卧床时间、住院时间、治疗费用、术后C反应蛋白(CRP)、术后并发症]的数据并使用RevMan5.3进行统计学分析。结果共纳入33项研究,共2630例患者,其中ERAT组1294例,LA组1336例。meta分析结果显示,两组术后12 h腹痛缓解率(RR=1.23,95%CI:1.06~1.43),分别以(d)或(h)为单位的卧床时间(WMD=-3.00,95%CI:-3.93~-2.07)、(WMD=-9.51,95%CI:-16.12~-2.90),住院时间(WMD=-2.44,95%CI:-2.90~-1.98),治疗费用(WMD=-3.00,95%CI:-5.34~-0.67),术后CRP(WMD=-4.94,95%CI:-7.43~-2.45)、术后并发症发生率(RR=0.24,95%CI:0.18~0.32)等比较差异有统计学意义(P<0.05)。结论EART在粪石崁顿型阑尾炎的治疗中较LA更有优势。

Objective To adopt the systematical evaluation method to compare the efficacies between endoscopic retrograde appendicitis therapy(ERAT)versus laparoscopic appendectomy(LA)for treating fecalith incarceration appendicitis.Methods The databases of PubMed,WANGFANG,CNKI,Cochrane Library and Embase were retrieved by computer.The retrieval time was 2016-2021.The EART related clinical trials were collected,the literatures conforming to the inclusion standard conducted the Jadad scoring,the basic situation of each study and various observation indications(abdominal pain relief,time in bed,hospitalization duration,hospitalization expenses,postoperative CRP,postoperative complications)in the ERAT group and LA group were extracted respectively.The RevMan 5.3 software was used for conducting the statistical analysis.Results A total of 33 trials with a total of 2630 patients were included.There were 1294 cases in the ERAT group and 1336 cases in the LA group.The meta analysis results showed that the remission rate of abdominal pain at postoperative 12 h(RR=1.23,95%CI:1.06-1.43),time in bed(with d or h as the unit,WMD=-3.00,95%CI:-3.93 to-2.07;WMD=-9.51,95%CI:-16.12 to-2.90),hospitalization duration(WMD=-2.44,95%CI:-2.90 to-1.98),treatment costs(WMD=-3.00,95%CI:-5.34 to-0.67),postoperative CRP(WMD=-4.94,95%CI:-7.43 to-2.45)and postoperative complications incidence rate(RR=0.24,95%CI:0.18-0.32)had statistical difference between the two groups(P<0.05).Conclusion ERAT has more advantages than LA in treating fecalith incarceration appendicitis.