Department of General Surgery, Royal Oldham Hospital, Oldham, UK.
World J Surg. 2010 Sep;34(9):2026-40. doi: 10.1007/s00268-010-0669-z.
The goal of the present study was to critically review and identify the strength of available evidence in the literature on the use of laparoscopic appendectomy (LA) in complicated appendicitis (CA).
The Cochrane Library and Controlled Trials Registry, MEDLINE (Ovid), PubMed, Web of knowledge, and SCOPUS databases were electronically searched, using the keywords "appendectomy," "laparoscopy," "appendicitis." "complicated appendicitis." "gangrenous appendicitis," "perforated appendicitis," with English language as a limit. Backward chaining was also employed. The NHS Public Health Resource Unit Critical Appraisal Skills Programme Tools were used for critical appraisal.
Twelve retrospective case-control studies were included in the review. Overall methodological quality was moderate to poor, with heterogeneity, absence of randomization and blinding, and presence of important methodological flaws. Meta-analysis showed that LA in CA has reduced surgical site infection (SSI) rates compared to open appendectomy (OA), odds ratio (OR) 0.23, 95% confidence intervals (CI): 0.14-0.37 (level 3a evidence), and no difference with regard to intra-abdominal abscess (IAA) complication rates OR: 1.02, 95% CI 0.56-1.86 (level 3a evidence).
When compared to OA, laparoscopic appendectomy is advantageous in CA with regard to SSIs, with no significant additional risk of IAA (level 3a evidence).
本研究旨在批判性地回顾和确定有关复杂性阑尾炎（CA）中腹腔镜阑尾切除术（LA）应用的文献中现有证据的强度。
电子检索 Cochrane 图书馆和对照试验登记处、MEDLINE（Ovid）、PubMed、Web of knowledge 和 SCOPUS 数据库，使用关键词“appendectomy”、“laparoscopy”、“appendicitis”、“complicated appendicitis”、“gangrenous appendicitis”、“perforated appendicitis”，并限制为英文。还采用了回溯链法。使用 NHS 公共卫生资源单位关键评估技能计划工具进行关键评估。
共纳入 12 项回顾性病例对照研究。总体方法学质量为中等到较差，存在异质性、缺乏随机化和盲法，以及存在重要的方法学缺陷。荟萃分析显示，与开腹阑尾切除术（OA）相比，LA 治疗 CA 可降低手术部位感染（SSI）率，比值比（OR）为 0.23，95%置信区间（CI）为 0.14-0.37（3a 级证据），且与腹腔脓肿（IAA）并发症发生率无差异 OR：1.02，95%CI 0.56-1.86（3a 级证据）。
与 OA 相比，LA 在 CA 中具有优势，可降低 SSI 发生率，且 IAA 的风险无显著增加（3a 级证据）。
