腹腔镜下脾切除术治疗外伤性脾破裂的Meta分析

摘要

目的 通过 Meta 分析比较腹腔镜脾切除术(laparoscopic splenectomy,LS)与开腹脾切除(open splenectomy,OS)治疗外伤性脾破裂的有效性及安全性.方法 计算机检索万方数据库、Medalink、中国知网(CNKI)、中国生物医学文献数据库、PubMed、Elsevier、SpringerLink.检索时限从 2008年1月至2017年12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 8 项随机对照试验或高质量对照研究文献、603例病人.结果 LS 在以下几方面优于 OS:降低术中出血[MD = - 115.57,95％ 置信区间(CI):(-213.82,-17.33),P ＜0.05];减少术后排气时间[MD = - 18.70,95％ CI:(- 19.84,- 17.56),P ＜0.05];术后住院时间[MD = -4.53,95％ CI:(- 6.44,- 2.62),P ＜ 0.05];术后并发症发生率[OR =0.25,95％ CI:(0.15,0.42),P ＜ 0.05].而 LS 和 OS 在手术时间方面无明显差异[MD = - 3.85,95％ CI:(-17.47,9.77),P ＞0.05].结论 与 OS 相比,LS 具有术中出血少、术后早期排气、平均住院时间短和减少术后并发症发生率等优点.LS 治疗外伤性脾破裂安全且有效,可在临床上推广.%Objective To compare the efficacy and safety of laparoscopic splenectomy (LS) and open splenectomy (OS) in the treatment of traumatic splenic rupture by Meta analysis. Methods Wanfang database,Medalink,CNKI, Chinese biomedical literature database, PubMed, Elsevier and SpringerLink were searched by computer. The search was conducted from January 2008 to December 2017 to identify all relevant literature and to trace the references of included studies. RevMan 5. 2 software was used for data analysis. Results Eventually,8 randomized controlled trials or high quality control studies and 603 patients were included into this study. Meta-analysis showed that LS was superior to OS in reducing intraoperative bleeding [MD= 115. 57,95％ CI: (- 213. 82, - 17. 33),P ＜ 0. 05],flatus time [MD = - 18. 70,95％ CI: (- 19. 84, - 17. 56),P ＜ 0. 05],postoperative hospital stay [MD = - 4. 53,95％ CI: (- 6. 44, - 2. 62),P ＜ 0. 05] and the incidence of postoperative complications [OR = 0. 25,95％ CI,(0. 15,0. 42),P ＜ 0. 05],while there was no significant difference in operation time between LS and OS[MD = - 3. 85,95％ CI: (- 17. 47,9. 77),P＜ 0. 05]. Conclusion Compared with OS,LS has the advantages of less intraoperative bleeding,early postoperative flatus,shorter average length of stay,and reduced incidence of postoperative complications. Laparoscopic splenectomy is safe and effective in the treatment of traumatic splenic rupture and can be spreaded in clinical practice.