Siddiqui Muhammad Rafay Sameem, Abdulaal Y, Nisar A, Ali H, Hasan F
Department of General Surgery, Benenden Hospital, Cranbrook, Kent, UK.
Pediatr Surg Int. 2011 Apr;27(4):359-66. doi: 10.1007/s00383-010-2698-y. Epub 2010 Aug 24.
The objective of this study is to meta-analyse the published literature comparing outcomes after open (ONF) versus laparoscopic Nissen fundoplication (LNF) for gastro-oesophageal reflux disease in children. Electronic databases were searched from January 1993 to October 2009. A systematic review was performed to obtain a summative outcome. Six comparative studies were analysed. There were 466 patients in the laparoscopic group and 255 in the open group. There was no significant difference in operative time between LNF compared with ONF (p = 0.35). Children stayed in hospital for less time after undergoing LNF compared with ONF [random effects model: SMD = 0.93, 95% CI (0.41, 1.44), z = 3.53, p < 0.01]. Children feed earlier after LNF [random effects model: SMD = 4.13, 95% CI (1.00, 7.27), z = 2.58, p < 0.001] and had less morbidity [fixed effects model: RR = 3.22, 95% CI (1.98, 5.25), z = 4.71, p < 0.01; random effects model: RR = 2.90, 95% CI (1.49, 5.66), z = 3.12, p < 0.01]. No difference in recurrence at 12 months was highlighted (p = 0.29). In conclusion, the laparoscopic Nissen's fundoplication in children may be considered a safe and effective alternative to open surgery; however, careful case selection is required.
本研究的目的是对已发表的文献进行荟萃分析，比较开放性（ONF）与腹腔镜下尼森胃底折叠术（LNF）治疗儿童胃食管反流病后的结局。检索了1993年1月至2009年10月的电子数据库。进行了系统评价以获得总结性结局。分析了六项比较研究。腹腔镜组有466例患者，开放组有255例患者。与ONF相比，LNF的手术时间无显著差异（p = 0.35）。与ONF相比，儿童接受LNF后住院时间更短[随机效应模型：标准化均数差（SMD）= 0.93，95%可信区间（CI）（0.41，1.44），z = 3.53，p < 0.01]。LNF后儿童进食更早[随机效应模型：SMD = 4.13，95%CI（1.00，7.27），z = 2.58，p < 0.001]且发病率更低[固定效应模型：相对危险度（RR）= 3.22，95%CI（1.98，5.25），z = 4.71，p < 0.01；随机效应模型：RR = 2.90，95%CI（1.49，5.66），z = 3.12，p < 0.01]。12个月时复发率无差异（p = 0.29）。总之，儿童腹腔镜下尼森胃底折叠术可被视为开放性手术的一种安全有效的替代方法；然而，需要仔细选择病例。
