腹腔镜与开腹脾切除联合贲门血管阻断治疗门脉高压症的Meta分析

摘要

目的 通过Meta分析比较腹腔镜脾切除联合贲门周围血管断流术(LS+ ED)与开腹脾切除联合贲门周围血管断流术(OS+ ED)治疗肝硬化门脉高压的有效性及安全性.方法 计算机检索万方数据库、Medalink、CNKI、PubMed、Elsevier、SpringerLink、中国生物医学文献数据库.检索时限从建库至2015年4月,查找所有相关文献,并追溯纳入研究的参考文献.最后挑选随机对照或高质量对照研究文献,使用Revman 5.2软件进行Meta分析.结果 最终共纳入7项随机对照试验或高质量对照研究文献、468例患者.结果显示LS在降低术中出血[WMD=214.67,95％ CI(198.74,230.60),P＜0.01]、减少术后排气时间[WMD=17.72,95％ CI(12.39,23.04),P＜0.01]和术后住院天数[WMD=3.75,95％ CI(3.28,4.23),P＜0.01]方面优于OS;而OS则可降低手术时间[WMD=-33.74,95％CI(-43.06,-24.42),P＜0.01],但LS和OS在术后并发症发生率方面无明显差异.结论 与OS相比,LS具有术中出血少、术后胃肠道功能恢复快及平均住院时间短的优点.腹腔镜脾切除联合贲门周围血管断流术治疗肝硬化伴门脉高压胃底食管静脉曲张安全有效,值得在临床上推广.%Objective To compare the safety and feasibility of laparoscopic splenectomy and esophagogastric devascularization (LS + ED) versus open splenectomy and esophagogastric devascularization (OS + ED) in treating portal hypertension using Meta-analysis.Methods Controlled trials comparing LS + ED and OS + ED in treating portal hypertension were electronically searched from Wan Fang Data Knowledge Service Platform,Medalink,CNKI,PubMed,Elsevier,SpringerLink and CBM disc.The most recent search was conducted in April 2015.All the relevant data and references were retrieved and screened.RevMan 5.2 was used for data analysis.Results Eventually,7 randomized controlled trials (RCTs) or high-quality case-controlled studies involving 468 patients were included into this study.Meta-analysis showed LS reduced blood loss [WMD =214.67,95％ CI 198.74-230.60,P ＜ 0.01],shortened flatus time [WMD =17.72,95％ CI 12.39-23.04,P ＜ 0.01] and postoperative hospital stay [WMD =3.75,95％ CI 3.28-4.23,P ＜ 0.01],while the duration of surgery was shorter in OS (P ＞ 0.05).However,OS was comparable with LS in complication rates.Conclusions Comparing with OS,LS had the advantages of reducing intraoperative blood loss and shortening recovery time after operation.In patients with cirrhosis,portal hypertension and esophageal varices,laparoscopic splenectomy was safe and effective.