腹腔镜与传统阑尾切除术随机对照试验的荟萃分析。
A meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy.
作者信息
Chung R S, Rowland D Y, Li P, Diaz J
机构信息
Department of Surgery, Huron Hospital, Cleveland Clinic Health Systems, Ohio, USA.
出版信息
Am J Surg. 1999 Mar;177(3):250-6. doi: 10.1016/s0002-9610(99)00017-3.
BACKGROUND
Despite many randomized controlled trials, the merits of laparoscopic appendectomy remain unclear. A meta-analysis may provide insights not evident from any individual studies.
DATA SOURCES
Systematic literature search yielded 17 trials (1,962 subjects) of true randomized design with usable statistical data comparing laparoscopic and conventional appendectomy in adults. The effect sizes for operating time, hospitalization, postoperative pain, return to normal activity, wound infection, and intra-abdominal abscess were calculated, using the random effects model to allow for heterogeneity. An estimate of the robustness of all positive findings was also calculated.
RESULTS
Modest but statistically significant effect sizes were found for four of the six outcome measures. Laparoscopic appendectomy takes 31% longer to perform, but results in less postoperative pain, faster recovery (by 35%), and lower wound infection rates (by 60%).
CONCLUSION
Laparoscopic appendectomy offers significant improvement in postoperative outcomes at the cost of a longer operation.
背景
尽管有许多随机对照试验，但腹腔镜阑尾切除术的优点仍不明确。荟萃分析可能会提供从任何单个研究中都不明显的见解。
数据来源
系统文献检索产生了17项真正随机设计的试验（1962名受试者），这些试验具有可用的统计数据，比较了成人腹腔镜阑尾切除术和传统阑尾切除术。计算了手术时间、住院时间、术后疼痛、恢复正常活动、伤口感染和腹腔内脓肿的效应大小，使用随机效应模型来考虑异质性。还计算了所有阳性结果的稳健性估计值。
结果
六项结局指标中的四项发现了适度但具有统计学意义的效应大小。腹腔镜阑尾切除术的手术时间长31%，但术后疼痛较轻，恢复更快（快35%），伤口感染率更低（低60%）。
结论
腹腔镜阑尾切除术以手术时间延长为代价，显著改善了术后结局。
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