中南大学学报（医学版）
中南大學學報（醫學版）
중남대학학보（의학판）
JOURNAL OF CENTRAL SOUTH UNIVERSITY (MEDICAL SCIENCES)
2014年
12期
1299-1305
,共7页
邝学军%段双妮%王建钧%彭钊
鄺學軍%段雙妮%王建鈞%彭釗
광학군%단쌍니%왕건균%팽쇠
阑尾切除术%腹腔镜%Meta分析%随机对照试验
闌尾切除術%腹腔鏡%Meta分析%隨機對照試驗
란미절제술%복강경%Meta분석%수궤대조시험
appendectomy%laparoscopic%Meta-analysis%randomized controlled trial
目的：评价单孔腹腔镜阑尾切除术( single-incision laparoscopic appendectomy，SILA)与传统腹腔镜阑尾切除术(conventional laparoscopic appendectomy，CLA)的安全性和有效性。方法：计算机检索各数据库中有关SILA与CLA的前瞻性随机对照试验。检索时限均为建库至2014年5月。按Cochrane系统评价员手册对纳入文献的方法学质量进行评价后提取数据，采用RevMan5.1统计软件行Meta分析。结果：筛选后最终纳入10项研究，共1183例患者，其中SILA组582例，CLA组601例。Meta分析结果显示，手术中转率SILA组高于CLA组(RR=4.38，95% CI 1.96~9.79，Z=3.59，P=0.0003)，手术时间SILA组长于CLA组(RR=4.83，95% CI 1.57~8.09， Z=2.90，P=0.004)，住院时间SILA组短于CLA组(WMD=?0.11，95% CI ?0.21~?0.01，Z=2.02，P=0.04)，术后切口外观评分SILA组优于CLA组(WMD=0.94，95% CI 0.49~1.40，Z=4.06，P<0.001)；术后并发症和术后疼痛评分两组间差异无统计学意义(RR=1.03，95% CI 0.74~1.45，Z=0.18，P=0.86；WMD=?0.19，95% CI ?0.59~0.20，Z=0.95，P=0.34)。结论：在有条件的医院经严格选择病例，SILA是一项安全有效的手术方式，尤其适用于对切口外观有强烈要求的病人。
目的：評價單孔腹腔鏡闌尾切除術( single-incision laparoscopic appendectomy，SILA)與傳統腹腔鏡闌尾切除術(conventional laparoscopic appendectomy，CLA)的安全性和有效性。方法：計算機檢索各數據庫中有關SILA與CLA的前瞻性隨機對照試驗。檢索時限均為建庫至2014年5月。按Cochrane繫統評價員手冊對納入文獻的方法學質量進行評價後提取數據，採用RevMan5.1統計軟件行Meta分析。結果：篩選後最終納入10項研究，共1183例患者，其中SILA組582例，CLA組601例。Meta分析結果顯示，手術中轉率SILA組高于CLA組(RR=4.38，95% CI 1.96~9.79，Z=3.59，P=0.0003)，手術時間SILA組長于CLA組(RR=4.83，95% CI 1.57~8.09， Z=2.90，P=0.004)，住院時間SILA組短于CLA組(WMD=?0.11，95% CI ?0.21~?0.01，Z=2.02，P=0.04)，術後切口外觀評分SILA組優于CLA組(WMD=0.94，95% CI 0.49~1.40，Z=4.06，P<0.001)；術後併髮癥和術後疼痛評分兩組間差異無統計學意義(RR=1.03，95% CI 0.74~1.45，Z=0.18，P=0.86；WMD=?0.19，95% CI ?0.59~0.20，Z=0.95，P=0.34)。結論：在有條件的醫院經嚴格選擇病例，SILA是一項安全有效的手術方式，尤其適用于對切口外觀有彊烈要求的病人。
목적：평개단공복강경란미절제술( single-incision laparoscopic appendectomy，SILA)여전통복강경란미절제술(conventional laparoscopic appendectomy，CLA)적안전성화유효성。방법：계산궤검색각수거고중유관SILA여CLA적전첨성수궤대조시험。검색시한균위건고지2014년5월。안Cochrane계통평개원수책대납입문헌적방법학질량진행평개후제취수거，채용RevMan5.1통계연건행Meta분석。결과：사선후최종납입10항연구，공1183례환자，기중SILA조582례，CLA조601례。Meta분석결과현시，수술중전솔SILA조고우CLA조(RR=4.38，95% CI 1.96~9.79，Z=3.59，P=0.0003)，수술시간SILA조장우CLA조(RR=4.83，95% CI 1.57~8.09， Z=2.90，P=0.004)，주원시간SILA조단우CLA조(WMD=?0.11，95% CI ?0.21~?0.01，Z=2.02，P=0.04)，술후절구외관평분SILA조우우CLA조(WMD=0.94，95% CI 0.49~1.40，Z=4.06，P<0.001)；술후병발증화술후동통평분량조간차이무통계학의의(RR=1.03，95% CI 0.74~1.45，Z=0.18，P=0.86；WMD=?0.19，95% CI ?0.59~0.20，Z=0.95，P=0.34)。결론：재유조건적의원경엄격선택병례，SILA시일항안전유효적수술방식，우기괄용우대절구외관유강렬요구적병인。
Objective: To evaluate the efficiency and safety for single-incision laparoscopic appendectomy (SILA) and conventional laparoscopic appendectomy (CLA). Methods: The literature of randomized controlled trials (RCTs) concerning SILA versus CLA was retrieved by searching the electronic databases from the inception date to May 2014. Methodological quality of the included trials was assessed by using the Cochrane Reviewers’ Handbook criteria, and the data were extracted and subjected to Meta-analysis by using RevMan 5.1 analysis sotfware. Results: A total of 1183 patients were ifnally selected atfer the screening. Among them, 582 cases underwent SILA and 601 cases underwent CLA. Meta-analysis results demonstrated that SILA was associated with higher conversion rate (RR=4.38, 95% CI 1.96–9.79,Z=3.59,P=0.0003), longer operative time (RR=4.83, 95% CI 1.57–8.09,Z=2.90,P=0.004), shorter length of hospital stay (WMD=?0.11, 95%CI ?0.21–?0.01,Z=2.02,P=0.04), and better scores for the postoperative appearance of incision (WMD=0.94, 95%CI 0.49–1.40,Z=4.06,P<0.001) compared with CLA; no signiifcant difference was observed in postoperative complications and postoperative pain scores (RR=1.03, 95% CI 0.74–1.45,Z=0.18,P=0.86; WMD=?0.19, 95%CI ?0.59–0.20,Z=0.95,P=0.34) between the 2 groups. Conclusion: For patients under the conditions of the strict selection, SILA is a safe and effective procedure for the treatment of adult acute appendicitis, especially apply to those who care about incision appearance.
