腹腔镜切除术与开腹切除术治疗阑尾炎有效性与安全性Meta分析.docVIP

腹腔镜切除术与开腹切除术治疗阑尾炎有效性与安全性Meta分析 　　[摘要] 目的 系?y评价腹腔镜切除术（LA）与开腹切除术（OA）治疗阑尾炎的效果及安全性。 方法 采用Cochrane系统评价方法，计算机检索PubMed、EMBASE、the Cochrane Controlled Trials Register、Medline、外文医学信息资源检索平台（FMRS）、中国知网（CNKI）、生物医学文献数据库（CBM）、万方，检索时间为建库至2015年2月。纳入文献为随机对照试验（RCT），并追溯纳入研究的参考文献。由2名研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后，采用RevMan 5.2软件进行Meta分析。结果 共纳入17篇RCT，3055例患者。Meta分析结果显示：①LA组切口感染率较OA组明显降低，差异有统计学意义[RD=-0.06，95%CI（-0.09，-0.03），P=0.0005]；②两组腹腔脓肿差异无统计学意义[RD=0.01，95%CI（-0.01，0.03），P=0.46]；③LA组手术时间长于OA组，差异有统计学意义[MD=9.49，95%CI（1.29，17.7），P=0.02]；④LA组住院时间短于OA组，差异有统计学意义[MD=-1.68，95%CI（-3.05，-0.31），P=0.02]；⑤术后早期OA疼痛评分较LA高。 结论 LA和OA用于治疗阑尾炎均安全有效，LA组的切口感染率、住院时间、术后早期疼痛评分优于OA组，但OA组的手术时间短于LA组，两者在腹腔脓肿方面无差异。 　　[关键词] 腹腔镜阑尾切除术；开腹阑尾切除术；阑尾炎；系统评价；Meta分析 　　[中图分类号] R656.8 [文献标识码] A [文章编号] 1673-7210（2017）01（a）-0048-05 　　[Abstract] Objective To evaluate the clinical effectiveness and safety of laparoscopic appendectomy versus open appendectomy. Methods Randomized controlled trials （RCTs） of appendicitis treated by laparoscopic appendectomy and open appendectomy were electronically searched from PubMed， EMBASE， the Cochrane Controlled Trials Register， Medline， FMRS， CNKI， CBM， Wanfang before February 2015. References of included studies were also retrieved. The literature was independently screened according to exclusion and criteria by two researchers and Meta-analysis was conducted using RevMan 5.2 software after data extraction and quality assessment. Results 17 RCTs were included involving 3055 patients. The results of Meta-analysis showed that compared with the open appendectomy， laparoscopic appendectomy had significant differences in lower wound infection rate [RD=-0.06， 95%CI （-0.09， -0.03）， P=0.0005]， longer operative time [MD=9.49， 95%CI （1.29， 17.7）， P=0.02]， shorter hospitalization time [MD=-1.68， 95%CI （-3.05， -0.31）， P=0.02]， lower pain scores of early postoperative. There was no statistically significant difference in incidence rate of peritoneal abscess between laparoscopic appendectomy and open a