急性胆囊炎患者腹腔镜手术时机选择Meta分析

摘要

目的 分析急性胆囊炎患者腹腔镜手术时机选择与临床效果的关系.方法 采用计算机文献检索和手动搜索方法,收集近年来国内外发表的有关急性胆囊炎患者行腹腔镜手术时机选择方案的文献,采用随机效应模型对其行Meta分析.对文献质量进行评价,然后采用Rev Man 5.0.21软件统计计算有关手术时机选择和手术时间、术中出血量及术后并发症发生情况的RR值和95%CI.结果 共纳入13篇文献进行Meta分析,中文8篇,英文5篇,共包含病例2535例,其中早期手术组1401例,延迟手术组1134例,有10篇为低偏倚风险,有3篇为中偏倚风险.随机效应模型Meta分析显示早期手术组手术时间较延迟手术组明显缩短(P=0.00,RR=-20.25,95%CI=-24.97~15.33),术中出血量也明显减少(P=0.00,RR=-12.58,95%CI=-29.36~5.78),术后并发症也显著减少(P=0.00,RR=0.63,95%CI=0.47~0.84).结论 急性胆囊炎患者于发病72小时内采用腹腔镜手术治疗不仅可以缩短手术时间,减少术中出血量,对减少术后并发症也有显著作用.%Objective To assess the operation time of laparoscopic operation for acute cholecystitis by Meta analysis.Methods The methods of computer literature retrieval and manual search were used to collect the research on the timing of laparoscopic surgery for acute cholecystitis in recent years,and the random effects model was used to conduct the Meta analyze.The quality of the literature was evaluated,and then the RevMan5.0.21 software was used to calculate the RR value and 95%CI of the operation time,bleeding volume and postoperative complications.Results A total of 13 articles were included in the Meta analysis,9 in Chinese,4 in English,2535 for a total number of cases,1401 in the early operation group,1134 in the delayed operation group,and 10 papers for low risk of bias,3 papers for bias risk.Meta analysis of the random effects model showed that the operation time of the early operation group was significantly shorter than that of the delayed operation group(P=0.00,RR=-20.25,95%CI=-24.97~15.33),and the intraoperative blood loss was also significantly reduced(P=0.00,RR=-12.58,95%CI=-29.36~5.78),then the postoperative complications were also significantly reduced(P=0.00,RR=0.63,95%CI=0.47~0.84).Conclusion The use of laparoscopic operation in the treatment of acute cholecystitis in patients with 72h could not only shorten the operation time and reduce the amount of bleeding,but also had a significant effect on reducing postoperative complications.