腹腔镜与开腹修补术治疗消化性溃疡穿孔的安全性与有效性 Meta 分析

摘要

目的：系统评价腹腔镜与开腹修补术治疗消化性溃疡穿孔的安全性及有效性。方法收集1990-01～2014-09公开发表的有关两种治疗方法的中文和英文文献并进行疗效比较分析。结果该研究共纳入6篇随机对照试验，共计682例患者，其中腹腔镜组362例，开腹组320例。 Meta分析结果显示，腹腔镜与开腹消化性溃疡穿孔修补术比较，腹腔镜组术中出血量少（ P＝0.000）、肠蠕动恢复时间短（ P＝0.002）、住院时间短（P＝0.000），术后主要并发症如切口感染（P＝0.000）、肺部感染（P＝0.04）、术后肠梗阻（P＝0.03）发生率低，而在手术时间（P＝0.37）、腹腔脓肿（P＝0.57）、术后死亡率（P＝0.34）方面，两组之间差异无统计学意义。结论腹腔镜手术治疗消化性溃疡穿孔创伤更小、出血量更少、术后恢复更快、术后主要并发症发生率较低，是一种安全可行的治疗手段。%Objective To study the safety and efficacy of laparoscopy and open repair for patients with perfo-rated peptic ulcer.Methods Articles published in Chinese and English were searched in the Cochrane Library and on the databases of PubMed, EMBASE, CNKI, Wanfang from January 1990 to September 2014, to meet the search-ing requirements.Meta-analysis was used to analyze the collected data.Results The data of 6 randomized clinical trials of acceptable quality were collected from the databases,including a total of 682 patients, 362 cases of laparo-scopic group and 320 cases of open group.The results showed that there were no statistically significant differences between laparoscopic and open surgery in the operative time(P=0.37), intra-abdominal abscess(P=0.57) and mor-tality(P=0.34).Conclusion Laparoscopic surgery is safe and feasible.However, more randomized controlled tri-als with a greater number of patients need to be performed to confirm such an assumption.