CAJ | 학술논문

目的：通过 Meta 分析腹腔镜辅助与开腹手术治疗先天性巨结肠的疗效与安全性，评价腹腔镜辅助一期手术根治先天性巨结肠的优势。方法检索1998年1月至2013年8月 Pubmed、西文生物医学期刊文献数据库、CCTR、CNKI、中国生物医学文献数据库发表的相关腹腔镜辅助与传统开腹手术治疗先天性巨结肠疗效比较的文献，比较手术时间、术中出血量、术后住院时间、胃肠功能恢复时间、术后早期并发症的发生率（切口感染、粘连性肠梗阻、尿潴留、术后出血）以及远期并发症的发生率（小肠结肠炎、大便失禁、便秘、污粪）。用 Review Manger 5．2软件进行 Meta 分析。结果共9篇文献入选，9篇文献记录先天性巨结肠手术患儿456例，其中腹腔镜手术239例，开腹手术195例。Meta 分析结果显示：腹腔镜手术较开腹手术出血少，住院时间短，差异有统计学意义（P 值均≤0．05），手术时间和术后胃肠功能恢复时间比较，差异无统计学意义（P 值均≥0．05），术后早期并发症的发生率分别为11．61％、21．53％，差异有统计学意义（P 值≤0．05），术后远期并发症率分别为32．90％、42．56％，差异无统计学意义（P 值≥0．05）。结论腹腔镜辅助一期手术根治先天性巨结肠创伤小，恢复快，能有效减少术后早期并发症的发生。
목적：통과 Meta 분석복강경보조여개복수술치료선천성거결장적료효여안전성，평개복강경보조일기수술근치선천성거결장적우세。방법검색1998년1월지2013년8월 Pubmed、서문생물의학기간문헌수거고、CCTR、CNKI、중국생물의학문헌수거고발표적상관복강경보조여전통개복수술치료선천성거결장료효비교적문헌，비교수술시간、술중출혈량、술후주원시간、위장공능회복시간、술후조기병발증적발생솔（절구감염、점련성장경조、뇨저류、술후출혈）이급원기병발증적발생솔（소장결장염、대편실금、편비、오분）。용 Review Manger 5．2연건진행 Meta 분석。결과공9편문헌입선，9편문헌기록선천성거결장수술환인456례，기중복강경수술239례，개복수술195례。Meta 분석결과현시：복강경수술교개복수술출혈소，주원시간단，차이유통계학의의（P 치균≤0．05），수술시간화술후위장공능회복시간비교，차이무통계학의의（P 치균≥0．05），술후조기병발증적발생솔분별위11．61％、21．53％，차이유통계학의의（P 치≤0．05），술후원기병발증솔분별위32．90％、42．56％，차이무통계학의의（P 치≥0．05）。결론복강경보조일기수술근치선천성거결장창상소，회복쾌，능유효감소술후조기병발증적발생。
Objective To assess the safety and efficacy of laparoscopic-assisted one-stage pull-through operation for Hirschsprung′s Disease(HD). Methods The original articles related to laparoscopic-assisted one-stage pull-through compared with open operations for HD published from January 1998 to August 2013 were Colleted in electronic databases(Pubmed,Foreign Medical Journal Service,Cochrane Controlled Trials Register, China National Knowledge Infrastructure,China Biology Medicine disc).9 articles were included,which com-pared the operation time,blood loss,length of postoperative hospital stays,bowel movements recovery time,rate of early-postoperative complications(wound infection,adhesive intestinal obstruction,urinary retention,postoper-ative hemorrhage),rate of late-postoperative complications(enterocolitis,fecal incontinence,constipation,soi-ling).Review Manger 5.2 software was used for Meta-analysis.Results A total of 456 patients with HD were enrolled.including 239 patients in laparoscopic-assisted one-stage pull-through operation and 195 patients in open operation.The intraoperative blood loss and the length of hospital stays were significantly less in laparo-scopic operation than that in open operation(P≤0.05).But there were no significant difference in operation time and first bowel movement time(P≥0.05).The early -postoperative complication rate was significantly lower in laparoscopic group than that in open group(11.61% vs 21.53%,P≤0.05).There were no significant difference in late-postoperative complication rate(32.90% vs 42.56%,P≥0.05)between two groups. Con-clusions Compared with open operations for HD,laparoscopic -assisted one -stage pull-through for HD is safe,which has lower operative damage and can recovery soon,it reduces the incidence of early-postoperative <br> complications.