腹腔镜肠粘连松解术与开腹手术治疗粘连性肠梗阻的Meta分析
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摘要
目的系统评价腹腔镜肠粘连松解术与开腹手术治疗粘连性肠梗阻的有效性及安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、ICTRP、CNKI、VIP、CBM和Wanfang Data数据库,收集腹腔镜肠粘连松解术与开腹手术治疗粘连性肠梗阻的随机对照试验(RCT),检索时限均为从建库至2017年3月。由2位评价者按照纳入与排除标准独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入31个研究,3293例患者,Meta分析结果显示,与开腹手术比较,腹腔镜肠粘连松解术能降低肠梗阻复发率(OR=0.18,95%CI 0.12~0.25,P<0.000 01)、总并发症发生率(OR=0.17,95%CI 0.13~0.23,P<0.000 01)、切口感染发生率(OR=0.21,95%CI 0.13~0.35,P<0.000 01)、肺部感染发生率(OR=0.35,95%CI 0.15~0.82,P=0.02)和术后肠漏发生率(OR=0.32,95%CI 0.15~0.70,P=0.005)。结论现有证据表明腹腔镜肠粘连松解术治疗粘连性肠梗阻的复发率和并发症发生率低。
Objective To systematically evaluate the efficacy and safety of laparoscopic adhesiolysis versus open surgery for adhesive small bowel obstruction. Methods The databases including Pub Med, EMbase, The Cochrane Librar y(Issue 3, 2017), ICTRP, CNKI, VIP, CBM and Wanfang Data were electronically searched to collect randomized controlled trials(RCTs) about laparoscopic adhesiolysis versus open surgery for adhesive small bowel obstruction patients from inception to March 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then metaanalysis was conducted by Rev Man 5.3 software. Results A total of 31 studies involving 3293 patients were included. The results of meta-analysis showed that, compared with the open surgery group, the laparoscopic adhesiolysis group could significantly reduce the recurrence rate(OR=0.18, 95%CI 0.12-0.25, P<0.000 01), overall complications(OR=0.17, 95%CI 0.13-0.23, P<0.000 01), wound infection(OR=0.21, 95%CI 0.13-0.35, P<0.000 01), pneumonia(OR=0.35, 95%CI 0.15-0.82, P=0.02) and intestinal fistula(OR=0.32, 95%CI 0.15-0.70, P=0.005). Conclusions Current evidence shows that laparoscopic adhesiolysis can reduce the recurrence rate and complications in adhesive small bowel obstruction. Due to the limited quality of included studies, more high quality studies are needed to verify the above conclusion.
Objective To systematically evaluate the efficacy and safety of laparoscopic adhesiolysis versus open surgery for adhesive small bowel obstruction. Methods The databases including Pub Med, EMbase, The Cochrane Librar y(Issue 3, 2017), ICTRP, CNKI, VIP, CBM and Wanfang Data were electronically searched to collect randomized controlled trials(RCTs) about laparoscopic adhesiolysis versus open surgery for adhesive small bowel obstruction patients from inception to March 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then metaanalysis was conducted by Rev Man 5.3 software. Results A total of 31 studies involving 3293 patients were included. The results of meta-analysis showed that, compared with the open surgery group, the laparoscopic adhesiolysis group could significantly reduce the recurrence rate(OR=0.18, 95%CI 0.12-0.25, P<0.000 01), overall complications(OR=0.17, 95%CI 0.13-0.23, P<0.000 01), wound infection(OR=0.21, 95%CI 0.13-0.35, P<0.000 01), pneumonia(OR=0.35, 95%CI 0.15-0.82, P=0.02) and intestinal fistula(OR=0.32, 95%CI 0.15-0.70, P=0.005). Conclusions Current evidence shows that laparoscopic adhesiolysis can reduce the recurrence rate and complications in adhesive small bowel obstruction. Due to the limited quality of included studies, more high quality studies are needed to verify the above conclusion.
引文
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