Purkayastha Sanjay, Constantinides Vasilis A, Tekkis Paris P, Athanasiou Thanos, Aziz Omer, Tilney Henry, Darzi Ara W, Heriot Alexander G
Department of Biosurgery and Surgical Technology, Imperial College London, London, United Kingdom.
Dis Colon Rectum. 2006 Apr;49(4):446-63. doi: 10.1007/s10350-005-0316-1.
This study was designed to compare outcomes between laparoscopic and open surgery for patients with diverticular disease by using meta-analytic techniques.
Comparative studies published between 1996 and 2004 of open vs. laparoscopic surgery for diverticular disease were included. The end points that were evaluated are operative and functional outcomes and adverse events. A random effects model was used during analysis of these outcomes; heterogeneity was assessed and sensitivity analysis was performed to account for bias in patient selection.
Twelve nonrandomized studies, incorporating 19,608 patients, were included in the analysis. One study with 18,444 patients accounted for 94.5 percent of the total sample. Laparoscopic surgery resulted in reduced infective (odds ratio, 0.61; P = 0.01), pulmonary (odds ratio, 0.4; P < 0.001), gastrointestinal tract (odds ratio, 0.75; P = 0.03), and cardiovascular complications (odds ratio, 0.28; P = 0.0008) with no significant heterogeneity. Operative time was longer with laparoscopic surgery (weighted mean difference, 67.59; P = 0.04), and length of stay was significantly shorter (weighted mean difference, -3.81; P < 0.0001); however, these outcomes demonstrated significant heterogeneity. These results remained significant throughout all the sensitivity analyses except when evaluating high-quality studies (when the study with 18,444 patients was excluded), in which only blood loss and length of stay were significantly in favor of the laparoscopic group.
The results for patients selected for laparoscopic surgery compared with open surgery for diverticular disease are equivalent with a potential reduction in complications and hospital stay. Laparoscopic surgery for diverticular disease performed by appropriately experienced surgeons in the elective setting may be safe and feasible; because of the potential of significant bias arising from the included studies, a randomized, controlled trial is recommended.
本研究旨在运用荟萃分析技术比较憩室病患者接受腹腔镜手术与开放手术的疗效。
纳入1996年至2004年间发表的关于憩室病开放手术与腹腔镜手术的比较研究。评估的终点指标为手术和功能结局以及不良事件。在分析这些结局时采用随机效应模型；评估异质性并进行敏感性分析以考虑患者选择中的偏倚。
分析纳入了12项非随机研究，共19608例患者。一项纳入18444例患者的研究占总样本的94.5%。腹腔镜手术导致感染（比值比，0.61；P = 0.01）、肺部（比值比，0.4；P < 0.001）、胃肠道（比值比，0.75；P = 0.03）和心血管并发症（比值比，0.28；P = 0.0008）减少，且无显著异质性。腹腔镜手术的手术时间较长（加权平均差，67.59；P = 0.04），住院时间显著缩短（加权平均差，-3.8１；P < 0.0001）；然而，这些结局显示出显著异质性。除评估高质量研究时（排除纳入18444例患者的研究）外，所有敏感性分析的结果均保持显著，在高质量研究中只有失血和住院时间显著有利于腹腔镜组。
与憩室病开放手术相比，接受腹腔镜手术患者的结果相当，且并发症和住院时间可能减少。在择期情况下，由经验丰富的外科医生进行的憩室病腹腔镜手术可能是安全可行的；由于纳入研究可能产生显著偏倚，建议进行随机对照试验。
