Tan Jane J Y, Tjandra Joe J
Department of Colorectal Surgery, Royal Melbourne Hospital and Epworth Colorectal Centre, Melbourne, Australia.
Dis Colon Rectum. 2007 May;50(5):576-85. doi: 10.1007/s10350-006-0855-0.
This study was designed to determine the safety and feasibility of laparoscopic surgery in Crohn's disease.
A search of published studies in English between January 1990 and February 2006 was performed by using the MEDLINE and PubMed databases and the Cochrane Central Register of Controlled Trials. The studies were reviewed by two independent assessors. Meta-analysis with the Forest plot was performed when raw data, means, and standard deviations were available.
The rate of conversion from laparoscopic to open surgery was 11.2 percent. Laparoscopic procedures took longer to perform compared with open procedures, with a weighted mean difference of 25.54 minutes (P = 0.03). Patients who underwent laparoscopic surgery had a more rapid recovery of bowel function, with a weighted mean difference of 0.75 days (P = 0.02) and were able to tolerate oral intake earlier, with a weighted mean difference of 1.43 days (P = 0.0008). The duration of hospitalization was shorter, with a weighted mean difference of 1.82 days (P = 0.02). Morbidity was lower for laparoscopic procedures compared with open procedures (odds ratio, 0.57; 95 percent confidence interval, 0.37-0.87; P = 0.01). The rate of disease recurrence was similar for both laparoscopic and open surgery.
Laparoscopic surgery for Crohn's disease takes longer to perform, but there are significant short-term benefits to the patient. The morbidity also is lower, and the rate of disease recurrence is similar. Therefore, laparoscopic surgery for Crohn's disease is both safe and feasible.
本研究旨在确定腹腔镜手术治疗克罗恩病的安全性和可行性。
利用MEDLINE、PubMed数据库以及Cochrane对照试验中心注册库，检索1990年1月至2006年2月间发表的英文研究。由两名独立评估人员对这些研究进行审查。当可获得原始数据、均值和标准差时，采用森林图进行荟萃分析。
腹腔镜手术转为开腹手术的比例为11.2%。与开腹手术相比，腹腔镜手术的操作时间更长，加权平均差为25.54分钟（P = 0.03）。接受腹腔镜手术的患者肠功能恢复更快，加权平均差为0.75天（P = 0.02），且能更早耐受经口进食，加权平均差为1.43天（P = 0.0008）。住院时间更短，加权平均差为1.82天（P = 0.02）。与开腹手术相比，腹腔镜手术的发病率更低（优势比，0.57；95%置信区间，0.37 - 0.87；P = 0.01）。腹腔镜手术和开腹手术的疾病复发率相似。
克罗恩病的腹腔镜手术操作时间更长，但对患者有显著的短期益处。发病率也更低，且疾病复发率相似。因此，克罗恩病的腹腔镜手术既安全又可行。
