中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2014年
9期
709-715
,共7页
高俊%张继燃%叶年源%陆琪%牛刚%王道荣
高俊%張繼燃%葉年源%陸琪%牛剛%王道榮
고준%장계연%협년원%륙기%우강%왕도영
阑尾炎%阑尾切除术%腹腔镜检查,单孔%随机对照试验%Meta分析
闌尾炎%闌尾切除術%腹腔鏡檢查,單孔%隨機對照試驗%Meta分析
란미염%란미절제술%복강경검사,단공%수궤대조시험%Meta분석
Appendicitis%Appendectomy%Laparoscopy,single-incision%Randomized controlled trials%Meta analysis
目的 系统评价经脐单孔和传统三孔腹腔镜阑尾切除术的安全性和疗效.方法 按Cochrane系统评价方法,计算机检索1996年1月至2013年1 1月的PubMed、EMBASE、the Cochrane Controlled Trials Register、中国期刊全文数据库、生物医学文献数据库及维普数据库.纳入文献为随机对照试验,经2名研究员独立提取信息并进行交叉比对,比较单孔腹腔镜阑尾切除术与传统三孔腹腔镜阑尾切除术,并观察两组手术时间、术后疼痛评分、术后住院时间、术后并发症、平均住院时间以及医疗费用等临床指标.采用RevMan 4.2软件进行Meta分析.采用I2检验对异质性进行定量分析.二分类变量采用优势比(OR)及95％可信区间(95％CI)表示,连续性变量采用加权均数差(WMD)及95％ CI表示.结果 共有8项试验、1444例患者纳入研究,成人和儿童分别为760例和684例.施行单孔腹腔镜阑尾切除术721例(单孔腹腔镜手术组),施行传统三孔腹腔镜阑尾切除术723例(传统三孔腹腔镜手术组).Meta分析结果显示:与传统三孔腹腔镜阑尾切除术比较,单孔腹腔镜阑尾切除术成人组和儿童组的手术时间均有所延长,且差异有统计学意义(WMD=4.40,7.39,95％CI:2.14～6.66,2.16 ～12.61,P＜0.05);而术后疼痛评分、术后并发症和住院时间等指标比较,差异无统计学意义(WMD=-0.34,95％ CI:-1.02 ～0.33;OR=0.97,95％CI:0.64～1.47;WMD=-0.19,95％ CI:-1.14～0.76,P＞0.05).单孔腹腔镜阑尾切除术儿童组医疗费用比传统三孔腹腔镜阑尾切除术高,差异有统计学意义(WMD =0.87,95％ CI:0.26～1.48,P＜0.05).结论 单孔腹腔镜阑尾切除术中及术后各项临床指标与传统三孔腹腔镜阑尾切除术比较无明显优势.因此,单孔腹腔镜阑尾切除术只是为阑尾炎患者提供了另一选择,而非首选术式.
目的 繫統評價經臍單孔和傳統三孔腹腔鏡闌尾切除術的安全性和療效.方法 按Cochrane繫統評價方法,計算機檢索1996年1月至2013年1 1月的PubMed、EMBASE、the Cochrane Controlled Trials Register、中國期刊全文數據庫、生物醫學文獻數據庫及維普數據庫.納入文獻為隨機對照試驗,經2名研究員獨立提取信息併進行交扠比對,比較單孔腹腔鏡闌尾切除術與傳統三孔腹腔鏡闌尾切除術,併觀察兩組手術時間、術後疼痛評分、術後住院時間、術後併髮癥、平均住院時間以及醫療費用等臨床指標.採用RevMan 4.2軟件進行Meta分析.採用I2檢驗對異質性進行定量分析.二分類變量採用優勢比(OR)及95％可信區間(95％CI)錶示,連續性變量採用加權均數差(WMD)及95％ CI錶示.結果 共有8項試驗、1444例患者納入研究,成人和兒童分彆為760例和684例.施行單孔腹腔鏡闌尾切除術721例(單孔腹腔鏡手術組),施行傳統三孔腹腔鏡闌尾切除術723例(傳統三孔腹腔鏡手術組).Meta分析結果顯示:與傳統三孔腹腔鏡闌尾切除術比較,單孔腹腔鏡闌尾切除術成人組和兒童組的手術時間均有所延長,且差異有統計學意義(WMD=4.40,7.39,95％CI:2.14～6.66,2.16 ～12.61,P＜0.05);而術後疼痛評分、術後併髮癥和住院時間等指標比較,差異無統計學意義(WMD=-0.34,95％ CI:-1.02 ～0.33;OR=0.97,95％CI:0.64～1.47;WMD=-0.19,95％ CI:-1.14～0.76,P＞0.05).單孔腹腔鏡闌尾切除術兒童組醫療費用比傳統三孔腹腔鏡闌尾切除術高,差異有統計學意義(WMD =0.87,95％ CI:0.26～1.48,P＜0.05).結論 單孔腹腔鏡闌尾切除術中及術後各項臨床指標與傳統三孔腹腔鏡闌尾切除術比較無明顯優勢.因此,單孔腹腔鏡闌尾切除術隻是為闌尾炎患者提供瞭另一選擇,而非首選術式.
목적 계통평개경제단공화전통삼공복강경란미절제술적안전성화료효.방법 안Cochrane계통평개방법,계산궤검색1996년1월지2013년1 1월적PubMed、EMBASE、the Cochrane Controlled Trials Register、중국기간전문수거고、생물의학문헌수거고급유보수거고.납입문헌위수궤대조시험,경2명연구원독립제취신식병진행교차비대,비교단공복강경란미절제술여전통삼공복강경란미절제술,병관찰량조수술시간、술후동통평분、술후주원시간、술후병발증、평균주원시간이급의료비용등림상지표.채용RevMan 4.2연건진행Meta분석.채용I2검험대이질성진행정량분석.이분류변량채용우세비(OR)급95％가신구간(95％CI)표시,련속성변량채용가권균수차(WMD)급95％ CI표시.결과 공유8항시험、1444례환자납입연구,성인화인동분별위760례화684례.시행단공복강경란미절제술721례(단공복강경수술조),시행전통삼공복강경란미절제술723례(전통삼공복강경수술조).Meta분석결과현시:여전통삼공복강경란미절제술비교,단공복강경란미절제술성인조화인동조적수술시간균유소연장,차차이유통계학의의(WMD=4.40,7.39,95％CI:2.14～6.66,2.16 ～12.61,P＜0.05);이술후동통평분、술후병발증화주원시간등지표비교,차이무통계학의의(WMD=-0.34,95％ CI:-1.02 ～0.33;OR=0.97,95％CI:0.64～1.47;WMD=-0.19,95％ CI:-1.14～0.76,P＞0.05).단공복강경란미절제술인동조의료비용비전통삼공복강경란미절제술고,차이유통계학의의(WMD =0.87,95％ CI:0.26～1.48,P＜0.05).결론 단공복강경란미절제술중급술후각항림상지표여전통삼공복강경란미절제술비교무명현우세.인차,단공복강경란미절제술지시위란미염환자제공료령일선택,이비수선술식.
Objective To compare the efficacy and safety of single-incision and conventional three-port laparoscopic appendectomy.Methods According to the Cochrane systematic review methods,literatures on the comparison of the effects of single-incision laparoscopic appendectomy (SILA) and conventional three-port laparoscopic appendectomy (CTLA) were searched for in the PubMed,EMBASE,the Cochrane Controlled Trials Register,CNKI,CBM and VIP database.Data including the operation time,pain visual analogue scales scores,duration of postoperative hospital stay,incidence of postoperative complications,mean time of hospital stay and cost between the SILA and CTLA were compared by 2 reviewers.RevMan 4.2 software was used for Meta analysis,and the heterogeneity of the study was analyzed using the 12 test.Categorical variables were presented by odds ratio and 95％ confidence interval (95％ CI),and continuous variables were presented by weighted mean difference (WMD) and 95％C1.Results Eight randomized controlled trials including 1 444 patients were selected.All the patients were subdivided into the adults group (760 patients) and the children group (684 patients).A total of 721 patients received SILA (SILA group) and 723 received CTLA (CTLA group).The operation time of patients who received SILA in the adults group and the children group were significantly longer than those who received CTLA (WMD =4.40,7.39,95％ CI:2.14-6.66,2.16-12.61,P ＜0.05).There were no significant difference in the pain visual analogue scales scores,incidence of postoperative complications and duration of hospital stay between patients who received SILA and CTLA in the adults group and the children group (WMD =-0.34,95 ％ CI:-1.02-0.33,OR=0.97,95％CI:0.64-1.47; WMD=-0.19,95％CI:-1.14-0.76,P＞0.05).The cost of patients who received SILA was significantly higher than those who received CTLA in the children group (WMD =0.87,95 ％ CI:0.26-1.48,P ＜ 0.05).Conclusions There is no obvious advantages of SILA in perioperative and postoperative outcomes when compared with CTLA.Therefore,SILA is only a possible alternative to CTLA other than the preferred method.
