中国普外基础与临床杂志

中国普外基础与临床杂志

腹腔镜与开腹手术治疗外伤性脾破裂效果的 meta 分析

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目的 比较腹腔镜与开腹手术在外伤性脾破裂患者中应用效果的差异。 方法 计算机检索 PubMed、Web of Science、中国知网、万方数据库及维普数据库中发表的关于腹腔镜手术与开腹手术治疗外伤性脾破裂的对比研究性文献,检索时间为 2007 年 1 月至 2017 年 1 月,采用 Stata 12.0 软件进行 meta 分析。 结果 ① 术中情况:与 OS 组相比,LS 组患者的手术时间 [SMD=–0.71,95% CI 为(–1.12,–0.30),P=0.001] 更短,术中出血量 [SMD=–1.53,95% CI 为(–2.28,–0.78),P<0.001] 更少。② 术后情况:与 OS 组比较,LS 组患者的术后肛门排气时间 [SMD=–2.47,95% CI 为(–3.24,–1.70),P<0.001]、术后下床活动时间 [SMD=–2.97,95% CI 为(–4.32,–1.62),P<0.001] 和住院时间 [SMD=–1.68,95% CI 为(–2.15,–1.21),P<0.001] 均较短。③ 总并发症发生率和各并发症发生率:与 OS 组比较,LS 组患者的术后总并发症发生率较低 [OR=0.29,95% CI 为(0.19,0.43),P<0.001]。与 OS 组比较,LS 组患者的感染 [OR=0.27,95% CI 为(0.13,0.55),P<0.001]、腹腔积液 [OR=0.36,95% CI 为(0.13,1.00),P=0.049]、出血 [OR=0.29,95% CI 为(0.10,0.90),P=0.032]、肠梗阻 [OR=0.34,95% CI 为(0.13,0.90),P=0.030]、切口脂肪液化 [OR=0.27,95% CI 为(0.08,0.94),P=0.040] 和切口裂开 [OR=0.17,95% CI 为(0.03,0.96),P=0.045] 的发生率均较低(P<0.05),但 2 组患者的脾切除后发热 [OR=0.41,95% CI 为(0.13,1.27),P=0.123]、胰瘘 [OR=0.40,95% CI 为(0.06,2.63),P=0.343]、肝功能损害 [OR=0.36,95% CI 为(0.10,1.34),P=0.127] 和血栓形成 [OR=0.33,95% CI 为(0.09,1.22),P=0.097] 发生率比较差异均无统计学意义。 结论 腹腔镜手术不仅能够显著降低外伤性脾破裂患者多种并发症的发生率,还能有效加快其术后康复,因而外伤性脾破裂患者行腹腔镜手术是安全和有利的。

Objective To investigate the difference of effect between laparoscopic and open surgery in patients with traumatic rupture of spleen. Methods The literatures on comparison of laparoscopic and open surgery in patients with traumatic rupture of spleen were retrieved in PubMed, Web of Science, CNKI, Wanfang, and VIP databases from Jan. 2007 to Jan. 2017, and then Stata 12.0 software was applied to present meta-analysis. Results ① The condition during operation: compared with the OS group, operative time of the LS group was shorter [SMD=–0.71, 95% CI was (–1.12, –0.30), P=0.001] and intraoperative blood loss of the LS group was less [SMD=–1.53, 95% CI was (–2.28, –0.78), P<0.001]. ② The postoperative condition: compared with the OS group, the postoperative anal exhaust time [SMD=–2.47, 95% CI was (–3.24, –1.70), P<0.001], postoperative ambulation time [SMD=–2.97, 95% CI was (–4.32, –1.62), P<0.001], and hospital stay [SMD=–1.68, 95% CI was (–2.15, –1.21), P<0.001] of the LS group were all shorter. ③ The overall incidence of complications and the incidence of complications: on the one hand, compared with the OS group, patients in the LS group had a lower overall incidence of postoperative complications [OR=0.29, 95% CI was (0.19, 0.43), P<0.001]. On the other hand, compared with the OS group, patients in the LS group had lower incidences of infection [OR=0.27, 95% CI was (0.13, 0.55), P<0.001], ascites [OR=0.36, 95% CI was (0.13, 1.00), P=0.049], bleeding [OR=0.29, 95% CI was (0.10, 0.90), P=0.032], ileus [OR=0.34, 95% CI was (0.13, 0.90), P=0.030], incision fat liquefaction [OR=0.27, 95% CI was (0.08, 0.94), P=0.040], and incision rupture [OR=0.17, 95% CI was (0.03, 0.96), P=0.045]. However, there was no statistical difference on splenectomy fever [OR=0.41, 95% CI was (0.13, 1.27), P=0.123], pancreatic fistula [OR=0.40, 95% CI was (0.06, 2.63), P=0.343], liver function lesion [OR=0.36, 95% CI was (0.10, 1.34), P=0.127], and thrombosis [OR=0.33, 95% CI was (0.09, 1.22), P=0.097] between the 2 groups. Conclusions Laparoscopic surgery can not only significantly reduce the incidence of multiple complications of traumatic rupture of spleen, but also can speed up the recovery rate of postoperative recovery. Therefore, it is safe and beneficial in treatment of patients with traumatic rupture of spleen.

关键词: 外伤性脾破裂; 腹腔镜手术; 开腹手术; 效果; meta 分析

Key words: traumatic rupture of spleen; laparoscopy; open surgery; effect; meta-analysis

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